Use of older controlled non-heart-beating donors for liver transplantation

Fukumori, Tatsuya; Kato, Tomoaki; Levi, David; Olson, Les; Nishida, Seigo; Ganz, Susan; Nakamura, Noboru; Madariaga, Juan; Ohkohchi, Nobuhiro; Satoh, Susumu; Miller, Joshua; Tzakis, Andreas G.

doi:10.1097/01.tp.0000061785.51689.b0

Cited by 57 publications

(50 citation statements)

References 16 publications

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“…Though ventilatory support is removed in the hospital under the supervision of medical personnel, they have no way of controlling how much time passes before cardiac death occurs (7,10). Furthermore, hypotensive episodes may result in a relative anoxia that precedes the actual heart stoppage and extends the total warm ischemic time (11). These are the DCD whose cardiac death is expected but not necessarily controlled.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the work that has been reported to date, however, involves controlled DCD (7,8,(10)(11)(12), and only two series of patients transplanted with uncontrolled DCD livers have been published. In one early American series (6), six uncontrolled DCD liver grafts were transplanted, five of which were lost in the posttransplant period, establishing a graft survival of 17%.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria

Fondevila¹,

Hessheimer²,

Ruíz³

et al. 2007

American Journal of Transplantation

278

197

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria

Fondevila¹,

Hessheimer²,

Ruíz³

et al. 2007

American Journal of Transplantation

278

197

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“…Interestingly, some groups have compared the outcomes with those with CNHBDs and BDDs and reported similar graft and recipient survival as well as a low postoperative complication rate. [8][9][10][11][12][13] It is accepted by most teams that CNHBD liver transplantation could be used as a strategy to increase the donor pool. However, many issues regarding UNHBDs remain unclear, and this keeps this graft source underused.…”

Section: Discussionmentioning

confidence: 99%

“…The indications for OLT in this group were alcoholic cirrhosis (n ϭ 18), hepatitis C cirrhosis (n ϭ 13), hepatitis B cirrhosis (n ϭ 6), hepatocellular carcinoma (n ϭ 2), and cryptogenic cirrhosis (n ϭ 1). The mean Child-Pugh score was 8.7 Ϯ 1.9 (range, [6][7][8][9][10][11][12], and the mean MELD score was 15.5 Ϯ 4.6 (range, 9-30).…”

Section: Recipient Characteristicsmentioning

confidence: 99%

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

et al. 2009

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Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n ϭ 1) for the UNHBD group and 0% for the BDD group (P ϭ 0.15). The rate of primary nonfunction was 10% (n ϭ 2) in UNHBD recipients and 2.5% (n ϭ 1) in BDD recipients (P ϭ 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P ϭ 0.012). After a mean follow-up of 330.4 Ϯ 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P ϭ 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P ϭ 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

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“…The incidence of primary nonfunction (PNF) using DCD livers has ranged from 0% to 5.5%, while biliary complication rates have been reported to be higher compared to DBD allografts (13-37% vs. 1-20%) (2,6,7). (2,(6)(7)(8)(9)(10). For instance, there are no widely accepted DCD donor parameters predictive of good outcomes that could guide surgeons on whether or not to use or discard a DCD liver.…”

Section: The Critical Shortage Of Organs Has Prompted a Marked Increamentioning

confidence: 99%

Liver Transplantation Using Donation After Cardiac Death Donors: Long-Term Follow-Up from a Single Center

Vera

Lopez-Solis

Dvorchik

et al. 2009

American Journal of Transplantation

300

286

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There is a lack of universally accepted clinical parameters to guide the utilization of donation after cardiac death (DCD) donor livers and it is unclear as to which patients would benefit most from these organs. We reviewed our experience in 141 patients who underwent liver transplantation using DCD allografts from 1993 to 2007. Patient outcomes were analyzed in comparison to a matched cohort of 282 patients who received livers from donation after brain death (DBD) donors. Patient survival was similar, but 1-, 5-and 10-year graft survival was significantly lower in DCD (69%, 56%, 44%) versus DBD (82%, 73%, 63%) subjects (p < 0.0001). Primary nonfunction and biliary complications were more common in DCD patients, accounting for 67% of early graft failures. A donor warm ischemia time >20 min, cold ischemia time >8 h and donor age >60 were associated with poorer DCD outcomes. There was a lack of survival benefit in DCD livers utilized in patients with model for end-stage liver disease (MELD) ≤30 or those not on organ-perfusion support, as graft survival was significantly lower compared to DBD patients. However, DCD and DBD subjects transplanted with MELD >30 or on organ-perfusion support had similar graft survival, suggesting a potentially greater benefit of DCD livers in critically ill patients.

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Use of older controlled non-heart-beating donors for liver transplantation

Abstract: In our preliminary experience, recipients of liver grafts from older CNHBDs had an outcome equivalent to that of younger CNHBDs. With the strict evaluation of the donors and brief CIT, liver grafts from older CNHBDs may be used to expand the donor pool.

Cited by 57 publications

References 16 publications

Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria

Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria

Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

Liver Transplantation Using Donation After Cardiac Death Donors: Long-Term Follow-Up from a Single Center

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