Impact of Resuscitated Cardiac Arrest in the Brain-dead Donors on the Outcome of Liver Transplantation: A Retrospective and Propensity Score Matching Analysis

Abstract

Objective: To evaluate the impact of cardiac arrest time (CAT) in brain-dead donors on graft and recipient outcomes following liver transplantation. Background: The outcome of livers from brain-dead donors with a history of cardiac arrest (CA) remains controversial, and the duration of the CAT has never been evaluated. Methods: A retrospective review of data from the Scientific Registry of Transplant Recipients between 2003 and 2022 was conducted. Propensity score matching was performed to minimize confounding effects. Results: A total of 115,202 recipients were included, 7364 (6.4%) and 107,838 (93.6%) of whom were of the CA and non-CA group, respectively. After 1:1 propensity score matching, each group consisted of 7157 cases. The CA group demonstrated shorter hospital stay (15.5 ± 20.0 days vs. 16.2 ± 21.3 days, P = 0.041), with comparable incidence of early graft failure (EGF, 5.8% vs. 6.2%, P = 0.161). The CA group demonstrated slightly higher graft survival rates (1 year, 90% vs. 88%; 5 years, 76% vs. 74%; and 10 years, 61% vs. 58%, P < 0.001). CAT positively correlated with EGF [odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.02–1.04, P < 0.001], with a sensitivity and specificity of 73% and 86% at a cutoff of 30 minutes. The CAT <30 minutes group demonstrated significantly lower incidence of EGF (5.0%), compared with 7.8% of the CAT >30 minutes group and 6.2% of the non-CA group (P < 0.001). Conclusions: The use of brain-dead donors with a history of CA did not increase the risk of liver graft failure in our study. A downtime of <30 minutes may confer protective effects on transplanted grafts.