Scarcity of donor organs in liver transplantation (LT) has necessitated consideration of extended criteria donors (ECDs), including donation after cardiac death (DCD) donors. The narrow window of opportunity for LT in fulminant hepatic failure (FHF) mandates consideration of ECDs. There is limited data regarding the impact of DCD allografts on outcome following LT for FHF. Aim: Compare the outcome of patients with FHF undergoing LT using DCD with those receiving donation after brain death (DBD) allografts. Methods: Using data from SRTR, a retrospective cohort was constructed of UNOS status 1A LT recipients who underwent LT for FHF over a ten year period (Jan 2004-Dec 2013). Those undergoing DCD LT were compared to DBD LT. Primary outcome measures evaluated were graft and patient survival. Graft failure was defined as the earlier of re-transplantation or death. Variables analyzed included donor and recipient age, gender, race, BMI, donor cause of death, warm and cold ischemia time. Chi square test was used for categorical variables and students t-test for continuous variables. Survival comparison was performed using Kaplan-Meier method (SAS ver. 9.0, Cary, NC). Results: 108 and 3235 patients respectively underwent DCD and DBT LT for FHF during the study period. Primary etiology in both groups was acetaminophen (APAP) overdose. Recipients in both groups were comparable with respect to all examined variables. Donor variables were also comparable except for mean donor age (33.9 vs. 38.5%; p=0.005) and proportion of females (29% vs 42%; p= 0.006), which were higher in the DBD group. One and 3 year graft survival was lower in the DCD group (71% vs 82.3%, p=0.001; 66.5% vs 75.6%, p=0.007). However, patient survival at 1 & 3 years in both groups was similar (82.6% vs. 86%, p=0.25; 78.1% vs. 80.4%, p=0.39). Conclusions: Even though graft survival is inferior in patients with FHF undergoing DCD LT, patient survival is similar to DBD recipients. Survival benefit after DCD LT in FHF is greater than the reported probability of LT free survival in FHF (US ALF study group: overall LT free survival 2006-2013: 56.2%; APAP 75.6%, non-APAP 39%). DCD grafts should therefore be considered in FHF, especially in non-APAP FHF. DCD LT for FHF could enable expansion of the donor pool in this subset of critically ill patients without compromising patient survival.

CITATION INFORMATION: Kumar S., Lin S., Schold J. Impact of Donation after Cardiac Death Allografts on Outcome Following Liver Transplantation for Fulminant Hepatic Failure: An Analysis of the UNOS Database Am J Transplant. 2017;17 (suppl 3).

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