Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study

نویسندگان

  • Christopher J Callaghan
  • Susan C Charman
  • Paolo Muiesan
  • James J Powell
  • Alexander E Gimson
  • Jan H P van der Meulen
چکیده

OBJECTIVES Outcomes of liver transplantations from donation after circulatory death (DCD) donors may be inferior to those achieved with donation after brain death (DBD) donors. The impact of using DCD donors is likely to depend on specific national practices. We compared risk-adjusted graft loss and recipient mortality after transplantation of DCD and DBD livers in the UK. DESIGN Prospective cohort study. Multivariable Cox regression and propensity score matching were used to estimate risk-adjusted HR. SETTING 7 liver transplant centres in the National Health Service (NHS) hospitals in England and Scotland. PARTICIPANTS Adults who received a first elective liver transplant between January 2005 and December 2010 who were identified in the UK Liver Transplant Audit. INTERVENTIONS Transplantation of DCD and DBD livers. OUTCOMES Graft loss and recipient mortality. RESULTS In total, 2572 liver transplants were identified with 352 (14%) from DCD donors. 3-year graft loss (95% CI) was higher with DCD livers (27.3%, 21.8% to 33.9%) than with DBD livers (18.2%, 16.4% to 20.2%). After adjustment with regression, HR for graft loss was 2.3 (1.7 to 3.0). Similarly, 3-year mortality was higher with DCD livers (19.4%, 14.5% to 25.6%) than with DBD livers (14.1%, 12.5% to 16.0%) with an adjusted HR of 2.0 (1.4 to 2.8). Propensity score matching gave similar results. Centre-specific adjusted HRs for graft loss and recipient mortality seemed to differ among transplant centres, although statistical evidence is weak (p value for interaction 0.08 and 0.24, respectively). CONCLUSIONS Graft loss and recipient mortality were about twice as high with DCD livers as with DBD livers in the UK. Outcomes after DCD liver transplantation may vary between centres. These results should inform policies for the use of DCD livers.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

The Implications of the Shift Toward Donation After Circulatory Death in Australia

Background In recent years, an increasing number of donor livers are being declined for transplantation in Australia. The aim of this study was to evaluate the impact of donation after cardiac death and other factors associated with organ quality on liver utilization rates in Australia. Methods Data on organ donors who donated at least 1 organ between 2005 and 2014 were obtained from the Aust...

متن کامل

Challenges and advances in optimizing liver allografts from donation after circulatory death donors

In recent years, there has been a shift in the donor demographics with an increase in donation after circulatory death (DCD). Livers obtained from DCD donors are known to have poorer outcomes when compared to donors after brainstem death and currently only a small proportion of DCD livers are used. This review outlines the recent technological developments in liver DCD donation, including clini...

متن کامل

Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors

BACKGROUND Liver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcom...

متن کامل

Donation after cardiac death as a strategy to increase deceased donor liver availability.

OBJECTIVE This study examines donation after cardiac death (DCD) practices and outcomes in liver transplantation. SUMMARY BACKGROUND DATA Livers procured from DCD donors have recently been used to increase the number of deceased donors and bridge the gap between limited organ supply and the pool of waiting list candidates. Comprehensive evaluation of this practice and its outcomes has not bee...

متن کامل

The frequency of organ donation and the clinical characteristics of donors with brain death before and after the outbreak of the COVID-19 pandemic in Rasht, Iran

Background: The COVID-19 pandemic has caused changes in daily life, disruption of hospital performance and medical services, especially in the organ transplant department. Objective: This study was conducted to compare the number and frequency of organ donation and transplantation in the period before and after the outbreak of the covid-19 pandemic in the transplant center of northern Iran. M...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:

دوره 3  شماره 

صفحات  -

تاریخ انتشار 2013