Survival following liver transplantation from non-heart-beating donors

Abstract

Objective: To determine whether patient and graft survival following transplantation with non-heart-beating donor (NHBD) hepatic allografts is equivalent to heart-beating-donor (HBD) allografts.

Summary background data: With the growing disparity between the number of patients awaiting liver transplantation and a limited supply of cadaveric organs, there is renewed interest in the use of hepatic allografts from NHBDs. Limited outcome data addressing this issue exist.

Methods: Retrospective evaluation of graft and patient survival among adult recipients of NHBD hepatic allografts compared with recipients of HBD livers between 1993 and 2001 using the United Network of Organ Sharing database.

Results: NHBD (N = 144) graft survival was significantly shorter than HBD grafts (N = 26856). One- and 3-year graft survival was 70.2% and 63.3% for NHBD recipients versus 80.4% and 72.1% (P = 0.003 and P = 0.012) for HBD recipients. Recipients of an NHBD graft had a greater incidence of primary nonfunction (11.8 vs. 6.4%, P = 0.008) and retransplantation (13.9% vs. 8.3%, P = 0.04) compared with HBD recipients. Prolonged cold ischemic time and recipient life support were predictors of early graft failure among recipients of NHBD livers. Although differences in patient survival following NHBD versus HBD transplant did not meet statistical significance, a strong trend was evident that likely has relevant clinical implications.

Conclusions: Graft and patient survival is inferior among recipients of NHBD livers. NHBD donors remain an important source of hepatic grafts; however, judicious use is warranted, including minimization of cold ischemia and use in stable recipients.

FIGURE 1. Number of liver transplants from NHBDs performed per year.

FIGURE 2. Kaplan-Meier graft survival for NHBDs and HBDs. NHBD graft survival (dotted line) was significantly less than HBD survival (solid line) at 1 (70.2 vs. 80.4%, P = 0.003) and 3 years (63.3 vs. 72.1%, P = 0.012).

FIGURE 3. Kaplan-Meier patient survival for NHBDs and HBDs. NHBD patient survival (dotted line) was similar to HBD (solid line) at 1 (79.7 vs. 85.0%, P = 0.082) and 3 years (72.1 vs. 77.4%, P = 0.146).

FIGURE 4. Kaplan-Meier NHBD graft survival for controlled donors (N = 117, solid line), uncontrolled donors (N = 11, small dashes), and unidentified patients (N = 16, large dashes).