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. 2014 May;14(5):1120-8.
doi: 10.1111/ajt.12700. Epub 2014 Apr 14.

Survival of recipients of livers from donation after circulatory death who are relisted and undergo retransplant for graft failure

A M Allen  1 , W R Kim, H Xiong, J Liu, P G Stock, J R Lake, S Chinnakotla, J J Snyder, A K Israni, B L Kasiske
Affiliations

Survival of recipients of livers from donation after circulatory death who are relisted and undergo retransplant for graft failure

A M Allen et al. Am J Transplant. 2014 May.

Abstract

Use of grafts from donation after circulatory death (DCD) as a strategy to increase the pool of transplantable livers has been limited due to poorer recipient outcomes compared with donation after brain death (DBD). We examined outcomes of recipients of failed DCD grafts who were selected for relisting with regard to waitlist mortality and patient and graft survival after retransplant. From the Scientific Registry of Transplant Recipients database, we identified 1820 adults who underwent first deceased donor liver transplant January 1, 2004 to June 30, 2011, and were relisted due to graft failure; 12.7% were DCD recipients. Compared with DBD recipients, DCD recipients had better waitlist survival (90-day mortality: 8%, DCD recipients; 14-21%, DBD recipients). Of 950 retransplant patients, 14.5% were prior DCD recipients. Graft survival after second liver transplant was similar for prior DCD (28% graft failure within 1 year) and DBD recipients (30%). Patient survival was slightly better for prior DCD (25% death within 1 year) than DBD recipients (28%). Despite higher overall graft failure and morbidity rates, survival of prior DCD recipients who were selected for relisting and retransplant was not worse than survival of DBD recipients.

Keywords: Graft survival; liver transplantation; outcomes; patient survival; waitlist mortality.

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Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Wait-list patient survival curves for the three groups for (panel A) the entire study period, 2004–2011 (panel B), era 1, 2004–2007, and (panel C) era 2, 2008–2011. The log-rank test result showed that survival was better for DCD liver recipients than for the other two groups. DBD-1, donation after brain death recipient relisted due to vascular thrombosis or biliary tract complications; DBD-2, donation after brain death recipient relisted due to any other causes; DCD, relisted donation after circulatory death recipient.
Figure 2
Figure 2
Graft survival after second liver transplant for (panel A) the entire study period, 2004–2011 (panel B), era 1, 2004–2007, and (panel C) era 2, 2008–2011. Graft survival appeared to be better for the prior DCD group, overall and for the recent era, but the differences were not statistically significant. No difference was seen for the early era. DBD, donation after brain death; DCD, donation after circulatory death.
Figure 3
Figure 3
Patient survival after second liver transplant for (panel A) the entire study period, 2004–2011 (panel B), era 1, 2004–2007, and (panel C) era 2, 2008–2011. Patient survival appeared to be better for the prior DCD group, overall and for the recent era, but the differences were not statistically significant. No difference was seen for the early era. DBD, donation after brain death; DCD, donation after circulatory death.
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References

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