Purpose: The use of donation after cardiac death (DCD) donors provides opportunity to help meet the demand for allografts needed for liver transplantation. However, concern remains that warm ischemia will impair graft function and survival and overall patient survival. The aim of this study was to evaluate the outcomes of liver transplantation between DCD donors and donation after brain death (DBD) donors with respect to complications, graft outcomes, and mortality.

Methods: All 971 adult liver transplant patients at our center between April 1, 2006 and June 30, 2014 were reviewed to identify two groups (with exclusions for Status 1A, retransplant, and multiorgan recipients): 60 patients received DCD donors and 791 patients received DBD donors. Comparison was made for patient survival, graft survivals, vascular complications, and biliary complications.

Results: Mean follow-up was 2938±43 days. The groups were similar with respect to donor and recipient demographics and clinical parameters. DCD allografts had a donation warm ischemia time of 19 minutes and arrest-to-cannulation of 7 minutes. Cold ischemia and anastomotic warm ischemia times for DCD and DBD allografts were 271 and 280 minutes and 33 and 34 minutes, respectively (p=0.598 and 0.579). DCD recipient had significantly higher AST and ALT in the immediate posttransplant period (p=.001 for both variables). There was no difference in patient mortality (p=0.528) or graft survival (p=0.361). Patient survival at 30 days, 1, 3, and 5 years was 97 %, 93 %, 86 %, and 86 % for DCD, respectively, and 97 %, 91 %, 85 % and 82 % for DBD, respectively. Graft survival at 30 days, 1, 3, and 5 years was 97 %, 93 %, 84 %, and 84 % for DCD, respectively, and 96 %, 88 %, 82 % and 78 % for DBD, respectively. Additionally, there was no significant differences in rates of primary nonfunction (p=0.461), vascular complications (p=0.571), or biliary complications (p=0.845). Specifically, ischemic-type intrahepatic biliary strictures were similar (p=0.179), found in 2 DCD recipients and 9 DBD recipients.

Conclusions: In our experience, the excellent patient and graft outcomes expected from DBD donors can also be achieved with DCD donors. Additionally, vascular and biliary complications, particularly ischemic-type intrahepatic biliary strictures, can be similar in both donor types.

CITATION INFORMATION: Vanatta J, Zhao X, Puri V, Helmick R, Nair S, Satapathy S, Eason J. Outcomes for Liver Transplantation Using Organs from Donation After Cardiac Death Donors: A Single Center Experience. Am J Transplant. 2016;16 (suppl 3).

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