SEATTLE — Livers from donors following cardiac death are being used to increase the supply of organs, but may be associated with higher rates of biliary complications and retransplantation, compared with those from donors with beating hearts, said Wendy Grant, M.D.
“Our recent experience supports these findings,” she said at the American Transplant Congress.
Given the current shortage of living-donor kidneys and livers available for transplantation, it has been necessary to look for any new source of organs to help prevent deaths on the waiting list. Among potential underused sources are donations after cardiac death (DCD), but there have been concerns about short- and long-term recipient outcomes.
Dr. Grant and her colleagues from the University of Nebraska, Omaha, performed a retrospective review of liver transplantation during a 10-month period in 2004, comparing donor and recipient demographics for both DCD and heart-beating donor (HBD) transplants. A total of 67 livers were transplanted into 63 patients, including 12 DCD organs.
The two groups of donor recipients were similar in age, Model for End-Stage Liver Disease score at the time of transplant, and hepatitis C status.
A higher percentage of DCD liver recipients had hepatocellular carcinoma, however, compared with those who received HBD organs (42% vs. 13%).
The time from extubation to organ flush was 15–36 minutes, with an average time of 24 minutes, said Dr. Grant. There was no incidence of primary organ malfunction in either group.
Patient survival at 9 months did not differ significantly between the DCD and HBD groups (100% vs. 88%), nor did the rate of graft survival (83% vs. 96%). “Biliary complications were higher in the DCD livers,” said Dr. Grant. Three DCD patients had complications, which occurred at 18, 20, and 44 days post transplant. One patient underwent a second transplant 24 days after the initial surgery. The second procedure was for diffuse bile duct necrosis. Two patients developed biliary casts, which were subsequently resolved.
The reasons for the development of biliary complications are unclear, as there were no obvious differences between the patients in the population who received livers from donors after cardiac death.
“We tried to see if there was any one factor, but there was nothing that jumped out. Everything was similar between the patients who had biliary complications and those who didn't,” Dr. Grant said at the congress, which was cosponsored by the American Society of Transplantation and the American Society of Transplant Surgeons.
“These grafts offer another source, as we are facing a shortage of organs, but they should be used selectively and with informed consent from the recipients,” she concluded.