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Liver Transplantation Using Uncontrolled Donors After Circulatory Death

A 10-year Single-center Experience

Jiménez-Romero, Carlos MD, PhD, FACS1,2; Manrique, Alejandro MD, PhD1,2; Calvo, Jorge MD, PhD1,2; Caso, Óscar MD, PhD1,2; Marcacuzco, Alberto MD, PhD1,2; García-Sesma, Álvaro MD, PhD1,2; Abradelo, Manuel MD, PhD1,2; Nutu, Anisa MD1,2; García-Conde, María MD1,2; San Juan, Rafael MD, PhD3; Justo, Iago MD, PhD1,2

doi: 10.1097/TP.0000000000002780
Original Clinical Science—Liver
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Background. One method for increasing the donor pool for orthotopic liver transplantations (OLTs) is to use uncontrolled donation after circulation death (uDCDs).

Methods. From January 2006 to December 2016, we performed 75 OLTs using uDCD livers. The control group comprised a sample of 265 OLTs using livers of donations after brain death (DBDs). A comparative study was performed.

Results. Of 256 potential uDCD donors cannulated, 75 (29.3%) livers were accepted for OLT. The amount of hemoderivatives transfused was significantly higher in the uDCD group. The rate of primary nonfunction was also significantly higher (P = 0.031) in uDCD recipients (8%) than DBD recipients (1.5%). The overall rate of biliary complications was significantly higher (P = 0.001) in uDCD recipients (23 cases, 30.6%) than DBD recipients (28 cases, 10.6%). In the uDCD group, 1-, 3-, and 5-year patient survival rates were 82.7%, 73%, and 71.5%, respectively; in the DBD group, they were 89%, 83.7%, and 78.8%, respectively (P = 0.180). In the uDCD group, 1-, 3-, and 5-year graft survival rates were 73.3%, 65.1%, and 63.6%, respectively; in the DBD group, they were 87.1%, 81.9%, and 76.5%, respectively (P = 0.013). Multivariate analysis showed that independent risk factors for patient and graft survival were intraoperative transfusion of >6 units of packed red blood cell concentrates and recipients who were older than 60 years.

Conclusions. Although graft survival is significantly lower using uDCD livers, 5-year patient survival in recipients of DBD and uDCD livers is similar. After careful selection, the livers of uDCD can be selectively used for OLT.

1 Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Department of Surgery, Doce de Octubre Hospital, Instituto de Investigación, Madrid, Spain.

2 Faculty of Medicine, Department of Surgery, Complutense University, Madrid, Spain.

3 Unit of Infectious Diseases, Doce de Octubre Hospital, Complutense University, Madrid, Spain.

Received 26 July 2018. Revision received 3 April 2019.

Accepted 9 April 2019.

C.J.-R.: Participated in research design and in the writing the article. A.M.: Participated in the performance of the research. A.M.: Participated in research design. J.C.: Participated in data analysis. Ó.C.: Participated in the performance of the research. Á.G.-S.: Participated in data analysis. M.A.: Participated in the performance of the research. A.N.: Participated in data analysis. M.G.-C.: Participated in data analysis. R.S.J.: Participated in the performance of the research. I.J.: Participated in research design and writing the article.

The authors declare no conflicts of interest.

I.J. presented this research as oral communication at the 27th International Congress of The Transplantation Society (2018) held in Madrid, Spain.

Correspondence: Carlos Jiménez-Romero, MD, PhD, FACS, Unit of HPB Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, 4ª Planta, Ctra. Andalucía Km 5.4, 28041 Madrid, Spain. (carlos.jimenez@inforboe.es).

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