Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Pan, Xiongxiong; Apinyachon, Worapot; Hong, Johnny C.; Busuttil, Ronald W.; Steadman, Randolph H.; Xia, Victor W.

doi:10.1002/lt.23888

Cited by 41 publications

(40 citation statements)

References 32 publications

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“…A previously published study with a smaller number of DCD patients (n = 74) showed similar PRBC and FFP transfusions in the postreperfusion period between DCD and DBD liver graft recipients. Also, the total volume of transfusion was less in both groups . When comparing our data to the aforementioned study, the current study had more DCD recipients, and the average numbers of products given per patient in both groups in the current study was less, making it difficult to draw a comparison between the 2 studies.…”

Section: Discussionmentioning

confidence: 61%

“…A previous small study demonstrated a higher incidence of intraoperative events (PRS, hyperkalemia, and cardiac arrest) in recipients of DCD liver grafts compared with recipients of DBD liver grafts. (4) The present study aims to provide the largest and most detailed analysis to date of intraoperative events in LT using liver grafts from DCD compared with DBD donors.…”

mentioning

confidence: 99%

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Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

et al. 2019

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Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait‐list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End‐Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.

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Section: Discussionmentioning

confidence: 61%

mentioning

confidence: 99%

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

et al. 2019

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“…An important link between IRI and PRS is similarly accounted by Pan et al[104] in their retrospective study, where they report a double incidence of PRS in DCD compared to DBD (25.7% vs 12.2%, respectively). These authors also suggest that the severe IRI experienced by DCD grafts during the additional warm ischaemia occurring before organ procurement may play a role in the development of PRS.…”

Section: Specific Intra-operative Risk Factors For Post-lt Prs-inducementioning

confidence: 74%

Acute kidney injury and post-reperfusion syndrome in liver transplantation

Umbro¹,

Tinti²,

Scalera³

et al. 2016

WJG

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In the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney injury AND DCD AND liver transplantation”. Accordingly, three out of five studies were selected for our purpose.

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“…PNF was defined as graft failure without secondary causes, leading either to retransplantation or death within the first posttransplant week. Early allograft dysfunction (EAD) was defined according to Olthoff et al Postoperative acute kidney injury (AKI) was defined according to the Risk, Injury, Failure, Loss and End‐Stage Kidney Disease criteria, and the need for continuous renal replacement therapy (CRRT) was also considered . Biliary complications included anastomotic and nonanastomotic biliary strictures, bile leaks, cholangitis, biliary casts, and stones requiring intervention or surgery .…”

Section: Methodsmentioning

confidence: 99%

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

et al. 2018

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Donation after circulatory death (DCD) in Italy constitutes a relatively unique population because of the requirement of a no-touch period of 20 minutes. The first aim of this study was to compare liver transplantations from donors who were maintained on normothermic regional perfusion after circulatory death and suffered extended warm ischemia (DCD group, n = 20) with those from donors who were maintained on extracorporeal membrane oxygenation (ECMO) and succumbed to brain death (ECMO group, n = 17) and those from standard donors after brain death (donation after brain death [DBD] group, n = 52). Second, we conducted an explorative analysis on the DCD group to identify relationships between the donor characteristics and the transplant outcomes. The 1-year patient survival for the DCD group (95%) was not significantly different from that of the ECMO group (87%; P = 0.47) or the DBD group (94%; P = 0.94). Graft survival was slightly inferior in the DCD group (85%) because of a high rate of primary nonfunction (10%) and retransplantation (15%) but was not significantly different from the ECMO group (87%; P = 0.76) or the DBD group (91%; P = 0.20). Although ischemic cholangiopathy was more frequent in the DCD group (10%), this issue did not adversely impact graft survival because none of the recipients underwent retransplantation due to biliary complications. Moreover, the DCD recipients were more likely to develop posttransplant renal dysfunction with the need for renal replacement therapy. Further analysis of the DCD group showed that warm ischemia >125 minutes and an Ishak fibrosis score of 1 at liver biopsy negatively impacted serum creatinine and alanine transaminase levels in the first posttransplant week, respectively. In conclusion, our findings encourage the use of liver grafts from DCD donors maintained by regional perfusion after proper selection.

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Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Cited by 41 publications

References 32 publications

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Acute kidney injury and post-reperfusion syndrome in liver transplantation

Liver Grafts From Donors After Circulatory Death on Regional Perfusion With Extended Warm Ischemia Compared With Donors After Brain Death

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