Variations in DCD Procurement Procedures across Opos and Their Effects on Liver Transplant Outcomes

A. P. Choubey¹, G. Mitro¹, E. J. Siskind², A. C. Ortiz³, M. Nayebpour⁴, N. Koizumi⁴, P. Wiederhold⁵, J. Ortiz¹

¹The University of Toledo, Toledo, OH, ²Inova Fairfax Hospital, Fairfax, VA, ³University of California, Los Angeles (UCLA), Los Angeles, CA, ⁴George Mason University, Fairfax, VA, ⁵Life Connection Of Ohio, Maumee, OH

Meeting: 2019 American Transplant Congress

Abstract number: 139

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

Session Information

Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues (DCD/ECD) I

Session Type: Concurrent Session

Date: Sunday, June 2, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 4:42pm-4:54pm

Location: Room 312

*Purpose: Variations in procurement procedures across Organ Procurement Organizations (OPOs) may account for discrepancies in outcomes of donation after cardiac death (DCD) liver transplants. We investigated the association between the procedure variations and liver transplant outcomes by linking procurement survey results from OPOs to UNOS data.

*Methods: A survey of all 58 OPOs inquiring about their practices of DCD organ procurement was conducted. The final data included transplants of liver between 2000 and 2016 (n = 3,613). We performed bivariate cox regressions and log-rank test to examine the impact of procurement practices on transplant outcomes. Transplant outcomes were measured using death-censored graft failure rate and patient mortality rate.

*Results: The survey results indicated substantial differences across OPOs in DCD procurement procedures. Cox regression analysis of the data showed that policy variations in the perfusion protocol, use of vasodilators and mandatory wait times after death had a statistically significant impact on transplant outcomes. The impact of policy variations in heparin use, location support withdrawal, and BMI cutoffs did not have a statistically significant impact on outcomes. The use of pre-mortem cannulation over rapid laparotomy was positively associated with increased graft mortality (HR = 1.210, p=0.000). Similarly, the use of vasodilators was associated with decreased graft failure (HR = 0.785, p = 0.002). Although the log-rank test did not show a significant difference in survival curves for pre-mortem cannulation and vasodilator use, a longer mandatory wait time presented with increased mortality at a 10% significance level. A waiting period of 5 minutes or longer was associated with increased post-operative graft failure (HR = 1.228, p = 0.022).

*Conclusions: There are substantial variations across OPO protocols for procuring DCD organs. These variations affect the transplant outcomes and patient mortality. Identification of factors associated with positive DCD liver transplant outcomes can be helpful in understanding risk factors and influencing informed policy reforms in OPO organ procurement process.

To cite this abstract in AMA style:

Choubey AP, Mitro G, Siskind EJ, Ortiz AC, Nayebpour M, Koizumi N, Wiederhold P, Ortiz J. Variations in DCD Procurement Procedures across Opos and Their Effects on Liver Transplant Outcomes [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/variations-in-dcd-procurement-procedures-across-opos-and-their-effects-on-liver-transplant-outcomes/. Accessed November 21, 2024.

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