Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Ryan M. Chadha, Kristopher P. Croome, Stephen Aniskevich, Sher Lu Pai, Justin Nguyen, Justin Burns, Dana Perry, C. Burcin Taner

Research output: Contribution to journalArticle

Abstract

Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait-list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End-Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.

Original languageEnglish (US)
JournalLiver Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Liver Transplantation
Tissue Donors
Brain Death
Transplants
Incidence
End Stage Liver Disease
Liver
Intraoperative Care
Thrombelastography
Biological Models
Hyperkalemia
Cardiopulmonary Resuscitation
Graft Survival
Blood Transfusion
Liver Diseases
Cardiac Arrhythmias
Hepatocellular Carcinoma
Transplantation
Erythrocytes
Mortality

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Chadha, R. M., Croome, K. P., Aniskevich, S., Pai, S. L., Nguyen, J., Burns, J., ... Taner, C. B. (Accepted/In press). Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors. Liver Transplantation. https://doi.org/10.1002/lt.25643

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors. / Chadha, Ryan M.; Croome, Kristopher P.; Aniskevich, Stephen; Pai, Sher Lu; Nguyen, Justin; Burns, Justin; Perry, Dana; Taner, C. Burcin.

In: Liver Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Chadha, Ryan M. ; Croome, Kristopher P. ; Aniskevich, Stephen ; Pai, Sher Lu ; Nguyen, Justin ; Burns, Justin ; Perry, Dana ; Taner, C. Burcin. / Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors. In: Liver Transplantation. 2019.
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abstract = "Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait-list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End-Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.",
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AB - Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait-list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End-Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.

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