Clinical outcomes in liver transplantation from donation after cardiac death

Abstract

Objective To investigate the clinical outcomes in liver transplantation from donation after cardiac death (DCD) . Methods The clinical data of 52 patients with end stage liver disease who received liver transplantation from DCD donors (the age of 21 pediatric recipients <18 years, and the age of 31 adult recipients≥18 years) at the Tianjin First Central Hospital from December 2008 to July 2013 were retrospectively analyzed. The intraoperative, postoperative and prognosis data were analyzed. All patients were regularly followed up in the Transplantation Follow-up Center after discharge till July 31 , 2014. The measurement data with normal distribution were presented as±s. The comparison between groups was evaluated with the repeated measures ANOVA. The cumulative survival rate was done by the Kaplan-Meier method. Results Among the 21 pediatric recipients, 16 received classic orthotopical liver transplantation and 5 received reduced-size liver transplantation from adult donors. The weight of 21 DCD livers, graft to recipient weight ratio (GRWR) , warm ischemia time, cold ischemia time, anhepatic phase, volume of intravenous infusion, operation time and volume of intraoperative blood loss were (338±34) g, 1. 9%±0. 7% , (16±6) minutes, (86±36) minutes, (43±10) minutes, (816±662) mL, (7. 1 ± 1. 5) hours and (329±214) mL, respectively. No peritoneal effusion, acute cellular rejection (ACR) , portal vein thrombosis (PVT) and biliary complications occurred in the pediatric recipients. The duration of hospital stay was (41±23) days. The level of hemoglobin (Hb) and albumin (Alb) to reach the normal level from pre-operation to postoperative day 14 were (101±19) g/ L to (128±23) g/ L and (34±7) g/L to (44±7) g/ L, respectively, with significant differences (F =3.943 , 7.340, P <0.05) . The level of total bilirubin (TBil) , aspartate transaminase (AST) and alanine transaminase (ALT) gradual reducing to the normal level from preoperation to postoperative day 14 were (307±69) μmol/ L to (34±17) μmol/ L, (88±34) U/ L to (36±17) U/ L and (154±51) U/ L to (46±18) U/ L, respectively, with significant differences (F =142.200, 17.060, 31.750, P <0.05) . Thirtyone adult recipients received classic orthotopical liver transplantation form adult donors. The weight of 21 DCD livers, GRWR, warm ischemia time, cold ischemia time, anhepatic phase, volume of intravenous infusion, operation time and volume of blood loss were (1 104 ± 43) g, 1. 7% ± 0. 4%, (16 ± 4) minutes, (89 ± 43) minutes, (47±9) minutes, (2 515±1 803) mL, (7. 9 ± 1.8) hours and (1 208 ± 548) mL, respectively. The complications occurred in 14 adult recipients, including peritoneal effusion in 8 recipients, ACR in 3 recipients, PVT in 2 recipients and biliary complications in 1 recipient. The duration of hospital stay was (44±22) days. The level of Alb to reach the normal level from pre-operation to postoperative day 14 were (31±5) g/ L to (40±5) g/ L, with a significant difference (F =14.930, P <0.05) . The level of TBil, AST and ALT gradual reducing to the nearly normal level from pre-operation to postoperative day 14 were (182 ± 55) μmol/ L to (62 ± 22) μmol/ L, (286 ± 93) U/ L to (79±47) U/ L and (349±111) U/ L to (76±28) U/ L, respectively, with significant differences (F = 34.350, 71.070, 82.680, P <0.05) . All the 52 recipients were followed up for a median time of 544 days (range, 196-1 953 days) , with 1-year survival rate of 90.38%. During the follow-up, 1 pediatric recipient died of pulmonary infection and 1 of massive hemorrhage, and 1 adult recipient died of pulmonary infection, 1 of primary graft dysfunction and 1 of massive hemorrhage. Conclusion Liver transplantation from DCD is a feasible treatment for end-stage liver diseases, with a good short-term clinical outcomes. Key words: End stage liver disease; Donation after cardiac death; Liver transplantation; Short-term outcomes; Clinical analysis