Abstract | BACKGROUND & AIMS: Organ scarcity has resulted in increased utilization of donation after cardiac death ( DCD) donors. Prior analysis of patient survival following DCD liver transplantation has been restricted to single institution cohorts and a limited national experience. We compared the current national experience with DCD and DBD livers to better understand survival after transplantation. METHODS: We compared 1113 DCD and 42,254 DBD recipients from the Scientific Registry of Transplant Recipients database between 1996 and 2007. Patient survival was analyzed using the Kaplan-Meier methodology and Cox regression. RESULTS:
DCD recipients experienced worse patient survival compared to DBD recipients (p<0.001). One and 3 year survival was 82% and 71% for DCD compared to 86% and 77% for DBD recipients. Moreover, DCD recipients required re- transplantation more frequently ( DCD 14.7% vs. DBD 6.8%, p<0.001), and re- transplantation survival was markedly inferior to survival after primary transplant irrespective of graft type. Amplification of mortality risk was observed when DCD was combined with cold ischemia time >12h (HR = 1.81), shared organs (HR = 1.69), recipient hepatocellular carcinoma (HR=1.80), recipient age >60 years (HR = 1.92), and recipient renal insufficiency (HR = 1.82). CONCLUSIONS:
DCD recipients experience significantly worse patient survival after transplantation. This increased risk of mortality is comparable in magnitude to, but often exacerbated by other well-established risk predictors. Utilization decisions should carefully consider DCD graft risks in combination with these other factors.
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Authors | Colleen Jay, Daniela Ladner, Edward Wang, Vadim Lyuksemburg, Raymond Kang, Yaojen Chang, Joseph Feinglass, Jane L Holl, Michael Abecassis, Anton I Skaro |
Journal | Journal of hepatology
(J Hepatol)
Vol. 55
Issue 4
Pg. 808-13
(Oct 2011)
ISSN: 1600-0641 [Electronic] Netherlands |
PMID | 21338639
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. |
Topics |
- Adult
- Age Distribution
- Carcinoma, Hepatocellular
(mortality, surgery)
- Death, Sudden, Cardiac
(epidemiology)
- Female
- Hepatitis C, Chronic
(mortality, surgery)
- Humans
- Liver Neoplasms
(mortality, surgery)
- Liver Transplantation
(mortality)
- Male
- Middle Aged
- Registries
(statistics & numerical data)
- Renal Insufficiency
(mortality)
- Reoperation
(mortality)
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Survival Analysis
- Tissue Donors
(statistics & numerical data)
- United States
(epidemiology)
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