Liver transplant using donors after cardiac death

A single-center approach providing outcomes comparable to donation after brain death

Jason M. Vanatta, Amanda G. Dean, Donna Hathaway, Satheesh Nair, Kian A. Modanlou, Luis Campos, Nosratollah Nezakatgoo, Sanjaya Satapathy, James D. Eason

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. The aim of this matched case control study was to determine if outcomes of liver transplants with donation after cardiac death donors is equivalent to outcomes with donation after brain death donors by controlling for careful donor and recipient selection, surgical technique, and preservation solution. Materials and Methods: A retrospective, matched case control study of adult liver transplant recipients at the University of Tennessee/Methodist University Hospital Transplant Institute, Memphis, Tennessee was performed. Thirty-eight donation after cardiac death recipients were matched 1:2, with 76 donation after brain death recipients by recipient age, recipient laboratory Model for End Stage Liver Disease score, and donor age to form the 2 groups. A comprehensive approach that controlled for careful donor and recipient matching, surgical technique, and preservation solution was used to minimize warm ischemia time, cold ischemia time, and ischemia-reperfusion injury. Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P=.444 and P=.295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P =.107). Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.

Original languageEnglish (US)
Pages (from-to)154-163
Number of pages10
JournalExperimental and Clinical Transplantation
Volume11
Issue number2
DOIs
StatePublished - Apr 1 2013

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Brain Death
Tissue Donors
Tissue and Organ Procurement
Transplants
Liver
Graft Survival
Case-Control Studies
Survival Rate
Cold Ischemia
Donor Selection
Warm Ischemia
End Stage Liver Disease
Reperfusion Injury
Allografts
Blood Vessels
Pathologic Constriction
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Liver transplant using donors after cardiac death : A single-center approach providing outcomes comparable to donation after brain death. / Vanatta, Jason M.; Dean, Amanda G.; Hathaway, Donna; Nair, Satheesh; Modanlou, Kian A.; Campos, Luis; Nezakatgoo, Nosratollah; Satapathy, Sanjaya; Eason, James D.

In: Experimental and Clinical Transplantation, Vol. 11, No. 2, 01.04.2013, p. 154-163.

Research output: Contribution to journalArticle

Vanatta, Jason M. ; Dean, Amanda G. ; Hathaway, Donna ; Nair, Satheesh ; Modanlou, Kian A. ; Campos, Luis ; Nezakatgoo, Nosratollah ; Satapathy, Sanjaya ; Eason, James D. / Liver transplant using donors after cardiac death : A single-center approach providing outcomes comparable to donation after brain death. In: Experimental and Clinical Transplantation. 2013 ; Vol. 11, No. 2. pp. 154-163.
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abstract = "Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. The aim of this matched case control study was to determine if outcomes of liver transplants with donation after cardiac death donors is equivalent to outcomes with donation after brain death donors by controlling for careful donor and recipient selection, surgical technique, and preservation solution. Materials and Methods: A retrospective, matched case control study of adult liver transplant recipients at the University of Tennessee/Methodist University Hospital Transplant Institute, Memphis, Tennessee was performed. Thirty-eight donation after cardiac death recipients were matched 1:2, with 76 donation after brain death recipients by recipient age, recipient laboratory Model for End Stage Liver Disease score, and donor age to form the 2 groups. A comprehensive approach that controlled for careful donor and recipient matching, surgical technique, and preservation solution was used to minimize warm ischemia time, cold ischemia time, and ischemia-reperfusion injury. Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P=.444 and P=.295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P =.107). Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.",
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AU - Nair, Satheesh

AU - Modanlou, Kian A.

AU - Campos, Luis

AU - Nezakatgoo, Nosratollah

AU - Satapathy, Sanjaya

AU - Eason, James D.

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N2 - Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. The aim of this matched case control study was to determine if outcomes of liver transplants with donation after cardiac death donors is equivalent to outcomes with donation after brain death donors by controlling for careful donor and recipient selection, surgical technique, and preservation solution. Materials and Methods: A retrospective, matched case control study of adult liver transplant recipients at the University of Tennessee/Methodist University Hospital Transplant Institute, Memphis, Tennessee was performed. Thirty-eight donation after cardiac death recipients were matched 1:2, with 76 donation after brain death recipients by recipient age, recipient laboratory Model for End Stage Liver Disease score, and donor age to form the 2 groups. A comprehensive approach that controlled for careful donor and recipient matching, surgical technique, and preservation solution was used to minimize warm ischemia time, cold ischemia time, and ischemia-reperfusion injury. Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P=.444 and P=.295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P =.107). Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.

AB - Objectives: Organ donation after cardiac death remains an available resource to meet the demand for transplant. However, concern persists that outcomes associated with donation after cardiac death liver allografts are not equivalent to those obtained with organ donation after brain death. The aim of this matched case control study was to determine if outcomes of liver transplants with donation after cardiac death donors is equivalent to outcomes with donation after brain death donors by controlling for careful donor and recipient selection, surgical technique, and preservation solution. Materials and Methods: A retrospective, matched case control study of adult liver transplant recipients at the University of Tennessee/Methodist University Hospital Transplant Institute, Memphis, Tennessee was performed. Thirty-eight donation after cardiac death recipients were matched 1:2, with 76 donation after brain death recipients by recipient age, recipient laboratory Model for End Stage Liver Disease score, and donor age to form the 2 groups. A comprehensive approach that controlled for careful donor and recipient matching, surgical technique, and preservation solution was used to minimize warm ischemia time, cold ischemia time, and ischemia-reperfusion injury. Results: Patient and graft survival rates were similar in both groups at 1 and 3 years (P=.444 and P=.295). There was no statistically significant difference in primary nonfunction, vascular complications, or biliary complications. In particular, there was no statistically significant difference in ischemic-type diffuse intrahepatic strictures (P =.107). Conclusions: These findings provide further evidence that excellent patient and graft survival rates expected with liver transplants using organ donation after brain death donors can be achieved with organ donation after cardiac death donors without statistically higher rates of morbidity or mortality when a comprehensive approach that controls for careful donor and recipient matching, surgical technique, and preservation solution is used.

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