Abstract
Donation after cardiac death (DCD) has expanded in the last decade in the US; however, DCD liver utilization has flattened in recent years due to poor outcomes. We examined clinical and quality of life (QOL) outcomes of DCD recipients by conducting a retrospective and cross-sectional review of patients from 2003 to 2010. We compared clinical outcomes of DCD recipients (n = 60) to those of donation after brain death (DBD) liver recipients (n = 669) during the same time period. DCD recipients had significantly lower rates of 5-year graft survival (P < 0.001) and a trend toward lower rates of 5-year patient survival (P = 0.064) when compared to the DBD cohort. In order to examine QOL outcomes in our cohorts, we administered the Short Form Liver Disease Quality of Life questionnaire to 30 DCD and 60 DBD recipients. The DCD recipients reported lower generic and liver-specific QOL. We further stratified the DCD cohort by the presence of ischemic cholangiopathy (IC). Patients with IC reported lower QOL when compared to DBD recipients and those DCD recipients without IC (P < 0.05). While the results are consistent with clinical experience, this is the first report of QOL in DCD recipients using standardized measures. These data can be used to guide future comparative effectiveness studies.
Highlights
Over the past decades, outcomes after liver transplantation (LT) have continuously improved with more than 80% oneyear patient survival along with significant improvements in recipient quality of life (QOL) [1, 2]
One strategy offered by the group was to increase the use of organs donated after cardiac death (DCD), which led to an expansion in the number of DCD LTs in the US [4]
Between January 1, 2003, and June 1, 2010, there were a total of 60 DCD LTs and 669 donation after brain death (DBD) LTs performed at our center
Summary
Outcomes after liver transplantation (LT) have continuously improved with more than 80% oneyear patient survival along with significant improvements in recipient quality of life (QOL) [1, 2]. With the severe organ shortage in the United States, over 16,000 patients are currently waiting for a LT [2]. Depending on the donation service area, approximately 10– 30% of LT candidates are removed from the waitlist prior to receiving a LT, due to either death or deteriorating medical condition [3]. One strategy offered by the group was to increase the use of organs donated after cardiac death (DCD), which led to an expansion in the number of DCD LTs in the US [4]. Increased use of DCD grafts has welldocumented negative medical sequelae, which have resulted in flattening in the growth of DCD liver utilization in the US [5]
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