Background

Donors after cardiac death (DCD) liver allografts have been underutilized in liver transplantation especially in case of old donor age due to concerns of worse outcomes. The aim of this study is to assess recent national outcomes with DCD donors older than 40 years and evaluate the impact of donor and recipient characteristics on graft survival.

Methods

The Scientific Registry of Transplant Recipients database was queried for adult liver transplants from DCD donors older than 40 years performed between 2009 and 2015. DCD donors were classified in 2 subgroups: donor age between 40 and 50 years, donor age older than 50 years. A multivariable Cox regression model was used to assess effects of donor, recipient, and center characteristics on graft survival.

Results

Between 2009 and 2015, 2139 patients underwent liver transplants with DCD allografts, of which 720 (33.7%) from donors older than 40 years. Only 13% of all DCD donors were older than 50 years, while during the same time period the percentage of brain dead donors older than 50 years was significantly higher (35.7%, p<0.01).

One- and 5- year graft survival rates after liver transplant from DCD donors older than 40 years were 83.1% and 66.1%. In the multivariable Cox regression model, risk factors associated with graft loss were cold ischemic time (CIT) longer than 8 hours (hazard ratio, HR: 1.94, 95%CI: 1.37-2.75, p<0.01), recipient in intensive care unit at time of transplant (HR: 2.40, 95%CI: 1.27-4.51, p<0.01), and low transplant center volume (HR:1.56, 95%CI: 1.13-2.16, p<0.01). A CIT < 8 hours was associated with higher 1-, 3-, and 5-year graft survival rates when compared to CIT > 8 hours (85.3%, 75.9%, 68.6% versus 68.8%, 59.4%, 51.2% respectively, p<0.01). Donor warm ischemic time, defined as time from donor extubation to aortic cannulation (median: 22 minutes, interquartile range: 18-26 minutes) was not associated with graft survival. Moreover, there was no difference in graft survival between DCD donors older than 50 years and DCD donors between 40 and 50 years of age.

Conclusion

A CIT less than 8 hours is desirable to achieve better graft survival especially in DCD donors older than 40 years. Adequate patient selection and center expertise are also associated with better DCD outcomes. Selected DCD donors older than 50 years may achieve graft survival rates similar to donors of 40-50 years of age and can be used to expand the donor pool.

CITATION INFORMATION: Paterno F., Wima K., Diwan T., Cuffy M., Anwar N., Woodle E., Shah S. Utilization of Older Donor after Cardiac Death Allografts in Liver Transplantation: An Opportunity to Increase the Donor Pool Am J Transplant. 2017;17 (suppl 3).

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