Effect of Modifying Life Support Withdrawal Practices on Outcomes of Donation After Circulatory Death in Liver Transplantation: A Meta-Analysis.

Y. Cao,^1,2 S. Shahrestani,³ H. Chew,^2,4 M. Crawford,⁵ P. Macdonald,^1,2,4 J. Laurence,^3,5,7 W. Hawthorne,^3,6 K. Dhital,^1,2,4 H. Pleass.^3,5,6

¹Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
²Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
³Sydney Medical School, University of Sydney, Sydney, NSW, Australia
⁴Cardiac Transplant Unit, St. Vincent's Hospital, Sydney, NSW, Australia
⁵Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
⁶The Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
⁷Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Meeting: 2016 American Transplant Congress

Abstract number: B91

Keywords: Donors, Liver transplantation, Meta-analysis, non-heart-beating, Outcome

Session Information

Session Name: Poster Session B: Donor Management: All Organs

Session Type: Poster Session

Date: Sunday, June 12, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Aim. Donor warm ischaemic time is identified as the main risk factor for poor outcomes in liver transplantation using donation after circulatory death (DCD) compared to using donation after brain death (DBD). However, benefits of minimizing this time has not been systematically explored. Therefore, we sought to investigate the influence of location of donor life support withdrawal, in either the intensive care unit (ICU) vs. operating theatre (OT) on outcomes. We additionally examined potential benefits of ante-mortem administration of heparin due to its proposed role in reducing micro-thrombi in DCD livers. Methods. A systematic search was conducted through EMBASE, Medline and Cochrane libraries and 23 studies were included for synthesis. Results. Compared to DBD recipients, one-year patient mortality (OT withdrawal: OR = 1.2, 95% CI 0.85-1.68; ICU withdrawal: OR = 2.15, 95% CI 1.15-4.02), one year graft loss (OT: OR = 1.65, 95% CI 1.16-2.36; ICU: OR = 1.98, 05% CI 1.13-3.47) and incidence of ischaemic cholangiopathy (OT: OR = 13.73, 95% CI = 5.18-36.44; ICU: OR = 19.68, 95% CI 7.48-51.75) were all reduced by withdrawal in OT compared to in ICU. Furthermore, the incidence of primary non-function was reduced by administration of heparin to the donor prior to withdrawal of life support (heparin: OR = 3.48, 95% CI 1.79-6.76; no heparin: OR = 11.24, 95% CI 1.99-63.37). Conclusions. Our evidence suggests that withdrawal of life support in the OT can confer significant benefits to outcomes for the recipients, thus facilitating optimal usage of these valuable organs. As such we recommend further evaluation of the outcomes from active withdrawal in the OT and ante-mortem administration of heparin.

CITATION INFORMATION: Cao Y, Shahrestani S, Chew H, Crawford M, Macdonald P, Laurence J, Hawthorne W, Dhital K, Pleass H. Effect of Modifying Life Support Withdrawal Practices on Outcomes of Donation After Circulatory Death in Liver Transplantation: A Meta-Analysis. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Cao Y, Shahrestani S, Chew H, Crawford M, Macdonald P, Laurence J, Hawthorne W, Dhital K, Pleass H. Effect of Modifying Life Support Withdrawal Practices on Outcomes of Donation After Circulatory Death in Liver Transplantation: A Meta-Analysis. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-modifying-life-support-withdrawal-practices-on-outcomes-of-donation-after-circulatory-death-in-liver-transplantation-a-meta-analysis/. Accessed December 6, 2023.

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