Donation after
cardiac death (
DCD) is an important source for expanding the donor pool for
liver transplantation (LT). Although the long-term outcomes of LT using
DCD grafts have been extensively studied, perioperative complications related to
DCD grafts are rarely reported. The aim of this study was to determine whether
DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed. Postreperfusion complications and posttransplant outcomes were compared between patients receiving
DCD grafts and patients receiving donation after
brain death (DBD) grafts. In all, 74 patients received
DCD grafts during the study period, and 1369 patients received DBD grafts. An initial comparison showed that many preoperative, prereperfusion, and donor variables in the
DCD group differed significantly from those in the DBD group. Propensity matching was chosen so that adjustments could be made for the differences. A postmatching analysis showed that the preoperative, prereperfusion, and donor variables no longer differed between the 2 groups. The postreperfusion requirements for blood products and vasopressors, the posttransplant ventilation times, the incidence of posttransplant
acute renal injury, and the 30-day and 1-year patient and graft survival rates were comparable between the 2 groups. However, patients receiving
DCD grafts experienced significantly higher rates of
hyperkalemia (33.8% versus 18.9%, P < 0.05) and postreperfusion syndrome (PRS; 25.7% versus 12.3%, P < 0.05). In conclusion, after adjustments for preoperative and prereperfusion risks via propensity matching,
DCD grafts remained a risk factor for postreperfusion
hyperkalemia and PRS. A prophylactic regimen aimed at decreasing postreperfusion
hyperkalemia and PRS is recommended for the management of LT using
DCD grafts.