Initial outcomes of using allografts from donation after cardiac death donors for liver transplantation in New South Wales.

OBJECTIVES To report the early outcomes of the initial selection and use of donation after cardiac death (DCD) donor livers for transplantation in New South Wales, following a guidelines implementation process. DESIGN AND SETTING Review of database and medical records from the Australian National Liver Transplantation Unit and the NSW Organ and T2 Donation Service for DCD activity including organ donor offers and retrievals, from 1 July 2007 to 31 December 2010. MAIN OUTCOME MEASURES Acceptance and utilisation rates of livers from DCD donors, and patient and graft outcomes after liver transplantation. RESULTS Of the potential 84 DCD donor offers, 45 were declined, and 15 of the 39 attempted retrievals provided livers for transplantation. The most common reason for non-retrieval of the liver was the time to declaration of death exceeding 30 minutes after withdrawal of treatment (14 donors), followed by abnormality in the donor liver (eight donors). Data on early outcomes for liver transplant recipients showed a median peak aspartate aminotransferase of 3667 U/L (range, 919-11 264 U/L), but no delayed graft function. Four patients developed biliary complications (two within 3 months and two later). Patient and graft survival were 100% at a median follow-up of 15 months. CONCLUSIONS As a result of the re-establishment of multiorgan donation through the DCD pathway, 15 (18%) of the selected DCD donors provided livers for transplantation. Patient and graft survival rates were excellent, and the rate of intra- and postoperative complications was acceptable. Hence, the selective transplantation of DCD donor liver allografts will continue to be pursued and the outcomes followed.