Longterm results of liver transplantation from donation after circulatory death

Joris J. Blok; Olivier Detry; Hein Putter; Xavier Rogiers; Robert J. Porte; Bart van Hoek; Jacques Pirenne; Herold J. Metselaar; Jan P. Lerut; Dirk K. Ysebaert; Valerio Lucidi; Roberto I. Troisi; Undine Samuel; A. Claire den Dulk; Jan Ringers; Andries E. Braat; Eurotransplant Liver Intestine

doi:10.1002/lt.24449

Longterm results of liver transplantation from donation after circulatory death

Joris J. Blok^*, Olivier Detry, Hein Putter, Xavier Rogiers, Robert J. Porte, Bart van Hoek, Jacques Pirenne, Herold J. Metselaar, Jan P. Lerut, Dirk K. Ysebaert, Valerio Lucidi, Roberto I. Troisi, Undine Samuel, A. Claire den Dulk, Jan Ringers, Andries E. Braat, Eurotransplant Liver Intestine

^*Corresponding author for this work

Groningen Institute for Organ Transplantation (GIOT)

Research output: Contribution to journal › Article › Academic › peer-review

89 Citations (Scopus)

Abstract

Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P <0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD

Original language	English
Pages (from-to)	1107-1114
Number of pages	8
Journal	Liver Transplantation
Volume	22
Issue number	8
DOIs	https://doi.org/10.1002/lt.24449
Publication status	Published - Aug-2016

Keywords

DONOR RISK INDEX
PERIOD PREDICTS DEVELOPMENT
CARDIAC DEATH
BILIARY COMPLICATIONS
SURVIVAL BENEFIT
SINGLE-CENTER
EXPERIENCE
ASYSTOLE
CRITERIA
AGE

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Longterm results of liver transplantation from donation after circulatory death
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Blok, J. J., Detry, O., Putter, H., Rogiers, X., Porte, R. J., van Hoek, B., Pirenne, J., Metselaar, H. J., Lerut, J. P., Ysebaert, D. K., Lucidi, V., Troisi, R. I., Samuel, U., den Dulk, A. C., Ringers, J., Braat, A. E., & Eurotransplant Liver Intestine (2016). Longterm results of liver transplantation from donation after circulatory death. Liver Transplantation, 22(8), 1107-1114. https://doi.org/10.1002/lt.24449

@article{85079aaf40064366bf434a6a383b6e03,

title = "Longterm results of liver transplantation from donation after circulatory death",

abstract = "Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7\% versus 74.8\%, respectively; P = 0.71), 5 years (65.6\% versus 54.4\%, respectively; P = 0.02), and 10 years (47.3\% versus 44.2\%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P <0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD",

keywords = "DONOR RISK INDEX, PERIOD PREDICTS DEVELOPMENT, CARDIAC DEATH, BILIARY COMPLICATIONS, SURVIVAL BENEFIT, SINGLE-CENTER, EXPERIENCE, ASYSTOLE, CRITERIA, AGE",

author = "Blok, \{Joris J.\} and Olivier Detry and Hein Putter and Xavier Rogiers and Porte, \{Robert J.\} and \{van Hoek\}, Bart and Jacques Pirenne and Metselaar, \{Herold J.\} and Lerut, \{Jan P.\} and Ysebaert, \{Dirk K.\} and Valerio Lucidi and Troisi, \{Roberto I.\} and Undine Samuel and \{den Dulk\}, \{A. Claire\} and Jan Ringers and Braat, \{Andries E.\} and \{Eurotransplant Liver Intestine\}",

year = "2016",

month = aug,

doi = "10.1002/lt.24449",

language = "English",

volume = "22",

pages = "1107--1114",

journal = "Liver Transplantation",

issn = "1527-6465",

publisher = "Wiley",

number = "8",

}

Blok, JJ, Detry, O, Putter, H, Rogiers, X, Porte, RJ, van Hoek, B, Pirenne, J, Metselaar, HJ, Lerut, JP, Ysebaert, DK, Lucidi, V, Troisi, RI, Samuel, U, den Dulk, AC, Ringers, J, Braat, AE & Eurotransplant Liver Intestine 2016, 'Longterm results of liver transplantation from donation after circulatory death', Liver Transplantation, vol. 22, no. 8, pp. 1107-1114. https://doi.org/10.1002/lt.24449

TY - JOUR

T1 - Longterm results of liver transplantation from donation after circulatory death

AU - Blok, Joris J.

AU - Detry, Olivier

AU - Putter, Hein

AU - Rogiers, Xavier

AU - Porte, Robert J.

AU - van Hoek, Bart

AU - Pirenne, Jacques

AU - Metselaar, Herold J.

AU - Lerut, Jan P.

AU - Ysebaert, Dirk K.

AU - Lucidi, Valerio

AU - Troisi, Roberto I.

AU - Samuel, Undine

AU - den Dulk, A. Claire

AU - Ringers, Jan

AU - Braat, Andries E.

AU - Eurotransplant Liver Intestine

PY - 2016/8

Y1 - 2016/8

N2 - Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P <0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD

AB - Donation after circulatory death (DCD) liver transplantation (LT) may imply a risk for decreased graft survival, caused by posttransplantation complications such as primary nonfunction or ischemic-type biliary lesions. However, similar survival rates for DCD and donation after brain death (DBD) LT have been reported. The objective of this study is to determine the longterm outcome of DCD LT in the Eurotransplant region corrected for the Eurotransplant donor risk index (ET-DRI). Transplants performed in Belgium and the Netherlands (January 1, 2003 to December 31, 2007) in adult recipients were included. Graft failure was defined as either the date of recipient death or retransplantation whichever occurred first (death-uncensored graft survival). Mean follow-up was 7.2 years. In total, 126 DCD and 1264 DBD LTs were performed. Kaplan-Meier survival analyses showed different graft survival for DBD and DCD at 1 year (77.7% versus 74.8%, respectively; P = 0.71), 5 years (65.6% versus 54.4%, respectively; P = 0.02), and 10 years (47.3% versus 44.2%, respectively; P = 0.55; log-rank P = 0.038). Although there was an overall significant difference, the survival curves almost reach each other after 10 years, which is most likely caused by other risk factors being less in DCD livers. Patient survival was not significantly different (P = 0.59). Multivariate Cox regression analysis showed a hazard ratio of 1.7 (P <0.001) for DCD (corrected for ET-DRI and recipient factors). First warm ischemia time (WIT), which is the time from the end of circulation until aortic cold perfusion, over 25 minutes was associated with a lower graft survival in univariate analysis of all DCD transplants (P = 0.002). In conclusion, DCD LT has an increased risk for diminished graft survival compared to DBD. There was no significant difference in patient survival. DCD allografts with a first WIT > 25 minutes have an increased risk for a decrease in graft survival. Liver Transplantation 22 1107-1114 2016 AASLD

KW - DONOR RISK INDEX

KW - PERIOD PREDICTS DEVELOPMENT

KW - CARDIAC DEATH

KW - BILIARY COMPLICATIONS

KW - SURVIVAL BENEFIT

KW - SINGLE-CENTER

KW - EXPERIENCE

KW - ASYSTOLE

KW - CRITERIA

KW - AGE

U2 - 10.1002/lt.24449

DO - 10.1002/lt.24449

M3 - Article

SN - 1527-6465

VL - 22

SP - 1107

EP - 1114

JO - Liver Transplantation

JF - Liver Transplantation

IS - 8

ER -

Longterm results of liver transplantation from donation after circulatory death

Abstract

Keywords

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