Long-term outcomes using uncontrolled donors after circulatory death (DCD) for liver transplantation. A 10-year single center experience

Abstract

Introduction: Number of liver grafts is not enough to attend all patients who need an OLT. Many OLT teams have proposed to expand the number of available grafts using livers from donors after circulatory death (DCD). We aim to analyse the use of liver grafts from type 2 uDCD donors for OLT, comparing with a group of patients who received liver grafts from donors after brain death (DBD). Patients and methods: Between January 2006 and December 2016 we performed 783 OLT in adult recipients. 75 of these transplants were DCD (Maastricht type II). We compared thus 75 DCD with 265 optimal donors OLT. Results: We present 75 DCD with a mean age 58.8 ± 8 vs 54.7 ± 10; p = 0,000, no different has found according to gender, body mass index, Child, MELD neither OLT indication. Donor age was 41.7 ± 10 vs 47.8 ± 15;p = 0.001; No different has found in Esteatosis, neither preservation injury, or cold ischemia time. Warm ischemia time was faster in DCD 62 min ± 14 vs 70 ± 36 (p = 0,010). Transfusion rate was significally higer in DCD in RBC, FFP, platelets and fibrinogen. Primary graft failure was higher in DCD 8.1% vs 2.1% (p = 0,031), also retransplant rate 12% vs 4.6% (0,028) and ischemic cholangiopathy 31,1% vs 5,6% (p = 0,000). Patient survival at 1, 3 and 5 years was in DCD: 81,3%, 70,2% and 68,6% vs DBD 89%, 83,7% and 78,8% p = 0,070. Conclusion: Even with a higher risk of primary graft failure and ischemic cholangiopathy, DCD type II is a safe source of donor for liver transplantation.