BACKGROUND

Donation after cardiac death (DCD) has been used as potential way to increase donor liver availability. The aim of this study was to compare early and late outcomes of patients undergoing orthotopic liver transplantation (OLT) for HCC using grafts from DCD and after brain death (DBD) donors in a single institution.

METHODS

All HCC patients undergoing OLT using DCD livers from 2006-2011 were identified from a prospectively maintained database and matched 1:1 to HCC patients using DBD livers by; age, gender, primary disease, Milan criteria, pre-transplant locoregional therapy, and year of surgery. We used the standard DCD protocol. The 2 groups were compared for postoperative outcomes, and overall survival (OS) and disease free survival (DFS). Patient survival was analyzed using the Kaplan–Meier methodology and Cox regression.

RESULTS

Out of 45 DCD donors grafts were used during the study period in our institution, 17 HCC patients received DCD grafts (85 % male) with mean age of 59.2 ± 8.5. The median follow-up period was 24.6+/- 19.3 months. The DCD and DBD groups had comparable initial liver graft function at 1, 7, and 30 days after liver transplantation. OS and DFS were similar between groups. 1-& 3-years OS of 94% and 73% for the DCD group vs. 92% and 70% for DBD group respectively (p=0.3). Also 1-&3- years DFS of 86 % and 66% for DCD group vs. 85% and 65% for DBD group respectively (p=0.8).We have 5 mortality in this cohort. 3 in the DCD group (one sepsis and 2 HCC recurrence) and 2 in DBD group due to HCC recurrence. The incidence of biliary complications were 23% (n =4) in DCD group vs. 6% (n=1) in DBD group, vascular complications was 12 %( n = 2) in DCD group vs. 0% in DBD group.

CONCLUSION

However, there is a higher incidence of biliary and vascular complications in DCD versus DBD groups, Livers from DCD can be used safely in patients with HCC with survival results comparable to DBD donors.

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