Comparison of Short-Term and Long-Term Outcomes After DCD and DBD Donor Liver Transplantation.

Abstract

Introduction: Liver transplantation (LT) using donation after cardiac death (DCD) allografts has been increased, however the occurrence of primary non-function (PNF) and ischaemic cholangiopathy (IC) has curbed their expansion. Here we compare the outcome of LT with donation after brain death (DBD) and DCD grafts performed in our institution. Study design: Between 2001-2013 we carried out 255 adult controlled DCD LT, which were compared to matched 255 DBD allografts. DCD grafts had a cut-off of maximum 30 min of warm ischaemia and were allocated to recipients with no previous extensive abdominal surgery. Results: There was no difference in gender and recipient's BMI between DBD and DCD transplants, however DBD donors were older and had longer cold ischaemic time. Patients that received DCD grafts presented higher levels of AST (p<0.0005), however, there was no significant difference in Intensive Care Unit or Hospital stay between the 2 groups. PNF was significantly higher in DCD allografts (p<0.0005); nevertheless, there was no statistically significant difference in the incidence of renal replacement therapy, rejection, biliary or vascular complications between the 2 groups. There were no significant differences in PIC occurrence between the 2 groups. Although more patients with hepatocellular carcinoma were allocated (64.06%) to a DCD graft, there was no difference in HCC recurrence. Overall patient and graft survival was higher in the DBD group (p =0.025, p=0.002). When transplants for HCC are excluded, no difference in overall patient and graft survival are observed. Conclusions: The data shows a favourable outcome of liver transplants using DCD allografts. More work is required to explore the impact of DCD status on HCC recurrence. Minimising CIT and optimising donor / recipient matching are crucial in order to achieve good outcome.