Comparing outcomes of donation after cardiac death versus donation after brain death in liver transplant recipients with hepatitis C: A systematic review and meta-analysis

Malcolm Wells, Kris Croome, Toni Janik, Roberto Hernandez-Alejandro, Natasha Chandok

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

BACKGROUND: Liver transplantation (LT) using organs donated after cardiac death (DCD) is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV) infection remains unclear due to the limited experience and number of publications addressing this issue. OBJECTIVE: To evaluate the clinical outcomes of DCD versus donation after brain death (DBD) in HCV-positive patients undergoing LT. METHODS: Studies comparing DCD versus DBD LT in HCV-positive patients were identified based on systematic searches of seven electronic databases and multiple sources of gray literature. RESULTS: The search identified 58 citations, including three studies, with 324 patients meeting eligibility criteria. The use of DCD livers was associated with a significantly higher risk of primary nonfunction (RR 5.49 [95% CI 1.53 to 19.64]; P=0.009; I 2=0%), while not associated with a significantly different patient survival (RR 0.89 [95% CI 0.37 to 2.11]; P=0.79; I2=51%), graft survival (RR 0.40 [95% CI 0.14 to 1.11]; P=0.08; I2=34%), rate of recurrence of severe HCV infection (RR 2.74 [95% CI 0.36 to 20.92]; P=0.33; I2=84%), retransplantation or liver disease-related death (RR 1.79 [95% CI 0.66 to 4.84]; P=0.25; I2=44%), and biliary complications. CONCLUSIONS: While the literature and quality of studies assessing DCD versus DBD grafts are limited, there was significantly more primary nonfunction and a trend toward decreased graft survival, but no significant difference in biliary complications or recipient mortality rates between DCD and DBD LT in patients with HCV infection. There is insufficient literature on the topic to draw any definitive conclusions.

Original languageEnglish (US)
Pages (from-to)103-108
Number of pages6
JournalCanadian Journal of Gastroenterology and Hepatology
Volume28
Issue number2
StatePublished - 2014
Externally publishedYes

Fingerprint

Brain Death
Hepatitis C
Meta-Analysis
Liver
Liver Transplantation
Virus Diseases
Graft Survival
Viruses
Transplant Recipients
Publications
Liver Diseases
Databases
Transplants
Recurrence
Survival
Mortality

Keywords

  • Biliary complications
  • Donation after cardiac death
  • Hepatitis C
  • Liver transplantation
  • Outcomes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Comparing outcomes of donation after cardiac death versus donation after brain death in liver transplant recipients with hepatitis C : A systematic review and meta-analysis. / Wells, Malcolm; Croome, Kris; Janik, Toni; Hernandez-Alejandro, Roberto; Chandok, Natasha.

In: Canadian Journal of Gastroenterology and Hepatology, Vol. 28, No. 2, 2014, p. 103-108.

Research output: Contribution to journalReview article

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title = "Comparing outcomes of donation after cardiac death versus donation after brain death in liver transplant recipients with hepatitis C: A systematic review and meta-analysis",
abstract = "BACKGROUND: Liver transplantation (LT) using organs donated after cardiac death (DCD) is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV) infection remains unclear due to the limited experience and number of publications addressing this issue. OBJECTIVE: To evaluate the clinical outcomes of DCD versus donation after brain death (DBD) in HCV-positive patients undergoing LT. METHODS: Studies comparing DCD versus DBD LT in HCV-positive patients were identified based on systematic searches of seven electronic databases and multiple sources of gray literature. RESULTS: The search identified 58 citations, including three studies, with 324 patients meeting eligibility criteria. The use of DCD livers was associated with a significantly higher risk of primary nonfunction (RR 5.49 [95{\%} CI 1.53 to 19.64]; P=0.009; I 2=0{\%}), while not associated with a significantly different patient survival (RR 0.89 [95{\%} CI 0.37 to 2.11]; P=0.79; I2=51{\%}), graft survival (RR 0.40 [95{\%} CI 0.14 to 1.11]; P=0.08; I2=34{\%}), rate of recurrence of severe HCV infection (RR 2.74 [95{\%} CI 0.36 to 20.92]; P=0.33; I2=84{\%}), retransplantation or liver disease-related death (RR 1.79 [95{\%} CI 0.66 to 4.84]; P=0.25; I2=44{\%}), and biliary complications. CONCLUSIONS: While the literature and quality of studies assessing DCD versus DBD grafts are limited, there was significantly more primary nonfunction and a trend toward decreased graft survival, but no significant difference in biliary complications or recipient mortality rates between DCD and DBD LT in patients with HCV infection. There is insufficient literature on the topic to draw any definitive conclusions.",
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T1 - Comparing outcomes of donation after cardiac death versus donation after brain death in liver transplant recipients with hepatitis C

T2 - A systematic review and meta-analysis

AU - Wells, Malcolm

AU - Croome, Kris

AU - Janik, Toni

AU - Hernandez-Alejandro, Roberto

AU - Chandok, Natasha

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Liver transplantation (LT) using organs donated after cardiac death (DCD) is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV) infection remains unclear due to the limited experience and number of publications addressing this issue. OBJECTIVE: To evaluate the clinical outcomes of DCD versus donation after brain death (DBD) in HCV-positive patients undergoing LT. METHODS: Studies comparing DCD versus DBD LT in HCV-positive patients were identified based on systematic searches of seven electronic databases and multiple sources of gray literature. RESULTS: The search identified 58 citations, including three studies, with 324 patients meeting eligibility criteria. The use of DCD livers was associated with a significantly higher risk of primary nonfunction (RR 5.49 [95% CI 1.53 to 19.64]; P=0.009; I 2=0%), while not associated with a significantly different patient survival (RR 0.89 [95% CI 0.37 to 2.11]; P=0.79; I2=51%), graft survival (RR 0.40 [95% CI 0.14 to 1.11]; P=0.08; I2=34%), rate of recurrence of severe HCV infection (RR 2.74 [95% CI 0.36 to 20.92]; P=0.33; I2=84%), retransplantation or liver disease-related death (RR 1.79 [95% CI 0.66 to 4.84]; P=0.25; I2=44%), and biliary complications. CONCLUSIONS: While the literature and quality of studies assessing DCD versus DBD grafts are limited, there was significantly more primary nonfunction and a trend toward decreased graft survival, but no significant difference in biliary complications or recipient mortality rates between DCD and DBD LT in patients with HCV infection. There is insufficient literature on the topic to draw any definitive conclusions.

AB - BACKGROUND: Liver transplantation (LT) using organs donated after cardiac death (DCD) is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV) infection remains unclear due to the limited experience and number of publications addressing this issue. OBJECTIVE: To evaluate the clinical outcomes of DCD versus donation after brain death (DBD) in HCV-positive patients undergoing LT. METHODS: Studies comparing DCD versus DBD LT in HCV-positive patients were identified based on systematic searches of seven electronic databases and multiple sources of gray literature. RESULTS: The search identified 58 citations, including three studies, with 324 patients meeting eligibility criteria. The use of DCD livers was associated with a significantly higher risk of primary nonfunction (RR 5.49 [95% CI 1.53 to 19.64]; P=0.009; I 2=0%), while not associated with a significantly different patient survival (RR 0.89 [95% CI 0.37 to 2.11]; P=0.79; I2=51%), graft survival (RR 0.40 [95% CI 0.14 to 1.11]; P=0.08; I2=34%), rate of recurrence of severe HCV infection (RR 2.74 [95% CI 0.36 to 20.92]; P=0.33; I2=84%), retransplantation or liver disease-related death (RR 1.79 [95% CI 0.66 to 4.84]; P=0.25; I2=44%), and biliary complications. CONCLUSIONS: While the literature and quality of studies assessing DCD versus DBD grafts are limited, there was significantly more primary nonfunction and a trend toward decreased graft survival, but no significant difference in biliary complications or recipient mortality rates between DCD and DBD LT in patients with HCV infection. There is insufficient literature on the topic to draw any definitive conclusions.

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KW - Donation after cardiac death

KW - Hepatitis C

KW - Liver transplantation

KW - Outcomes

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