Heart Care Info - Heart Disease Prevention & Treatment

Donation after cardiac death liver transplantation: Time for policy to catch up with practice

AI Skaro, E Wang, V Lyuksemburg... - Liver ..., 2012 - Wiley Online Library Donation after brain death (DBD) is the predominant source of organs for transplantation, even though brain death accounts for only a small percentage of all-cause mortality in the United States. 1 In contrast, cardiovascular death is a leading cause of mortality. 2 ...

Making decisions about the optimal utilization of DCD livers is more complicated than the mere consideration of the associated donor and transplant related risks. Not surprisingly, recipient factors also play an important role in predicting the outcomes of DCD transplantation.10, 11, 19, 20 Mateo et al.20 demonstrated that the risk stratification of recipients by age, medical condition, previous transplantation, dialysis, and renal impairment had a greater impact on graft survival than DCD donor and transplant parameters. In contrast, Lee et al.19 demonstrated a similarly negative impact on graft survival due to donor and recipient factors. The composite risk of adverse outcomes associated with DCD liver transplantation can be presented alternatively as the number needed to harm. Interestingly, the numbers needed to harm for ischemic cholangiopathy, primary nonfunction, graft failure, retransplantation, and patient mortality at 1 year are 7, 48, 10, 13, and 22, respectively.13 Clearly, the risks associated with DCD liver utilization are not prohibitive, but they should be tempered against the risk of recipient mortality on the wait list. Schaubel et al.29 established that the transplantation of livers with a high donor risk index provided a survival benefit for candidates with high Model for End Stage Liver Disease (MELD) scores but not for candidates with low scores.29 More recently, we sought to identify subpopulations of patients who derived the greatest benefit from DCD livers.30 We found that candidates with MELD scores higher than 20 and candidates with hepatocellular carcinoma beyond the Milan criteria benefited from DCD liver transplantation in comparison with remaining on the wait list for a DBD liver.