Increased Use of Donation After Cardiac Death Donors Increases Access to Transplantation without Adverse Effect on Outcomes.
UT/Methodist University Hospital, Memphis, TN
Meeting: 2017 American Transplant Congress
Abstract number: 144
Keywords: Liver transplantation, Waiting lists
Session Information
Session Name: Concurrent Session: Liver Allocation, Utilization, and Machine Perfusion
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: E451a
Introduction
As the transplant community discusses redistricting to address potential imbalance in loco-regional liver distribution, liver transplant programs will need to identify strategies to maximize access to transplantation for their listed patients. Our center recently experienced a change in local liver availability. We hypothesize that more liberal utilization of donation after cardiac death (DCD) liver donors is an effective strategy to increase the number of available organs for transplantation.
Methods
We retrospectively reviewed our prospectively maintained transplant database from 2006 through November 2016, identifying all liver transplant alone (LTA) recipients. The study period was divided into 2 eras based on the end of a statewide sharing variance. All DCD donors since 2013 received injection of tissue plasminogen activator via the hepatic artery at procurement and arterial reperfusion. Transplant rates were compared utilizing Chi-Square analysis.
Results
Throughout the study period we maintained a consistent number of LTA near 110 per year. During Era 1 we performed 761 LTAs, of which 48 were DCD transplants (6.3%), while in Era 2 we performed 433 LTAs, of which 56 were DCD transplants (12.9%) (p<0.001). Currently we are performing 16.8% of LTAs from DCD donors. We also noted a significant difference in number of DCD transplants by year (p=.002). Despite increased volume of DCD transplants, our ischemic cholangiopathy (IC) rate from Era 1 to Era 2 fell from 6.3% to 3.6%.
| Year | #DCD | #LTA | %DCD | |
| Era 1 | 2006 | 4 | 86 | 4.7% |
| 2007 | 13 | 101 | 12.9% | |
| 2008 | 8 | 116 | 6.9% | |
| 2009 | 2 | 117 | 1.7% | |
| 2010 | 5 | 110 | 4.5% | |
| 2011 | 8 | 125 | 6.4% | |
| 2012 | 8 | 106 | 7.5% | |
| Era 2 | 2013 | 12 | 109 | 11.0% |
| 2014 | 14 | 110 | 12.7% | |
| 2015 | 13 | 113 | 11.5% | |
| 2016* | 17 | 101 | 16.8% |
*Through 11/30/2016
Conclusions
Our increased use of DCD allografts has helped our program maintain access to liver transplantation despite a loss of a significant number of local donors and brain-dead donors (DBD). As transplant programs discuss changes to loco-regional distribution schemes, we advocate that increased utilization of DCD allografts can help meet the demands of changing liver distribution without compromising transplant outcomes.
CITATION INFORMATION: Helmick R, Eason J, Satapathy S, Vanatta J. Increased Use of Donation After Cardiac Death Donors Increases Access to Transplantation without Adverse Effect on Outcomes. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Helmick R, Eason J, Satapathy S, Vanatta J. Increased Use of Donation After Cardiac Death Donors Increases Access to Transplantation without Adverse Effect on Outcomes. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/increased-use-of-donation-after-cardiac-death-donors-increases-access-to-transplantation-without-adverse-effect-on-outcomes/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress