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Multicenter Study
. 2020 Oct 1;155(10):917-924.
doi: 10.1001/jamasurg.2020.2479.

Evaluation of Liver Graft Donation After Euthanasia

Marjolein van Reeven  1 , Nicholas Gilbo  2   3 , Diethard Monbaliu  2   3 , Otto B van Leeuwen  4 , Robert J Porte  4 , Dirk Ysebaert  5 , Bart van Hoek  6 , Ian P J Alwayn  7 , Nicolas Meurisse  8 , Olivier Detry  8 , Laurent Coubeau  9 , Olga Cicarelli  9 , Frederik Berrevoet  10 , Aude Vanlander  10 , Jan N M IJzermans  1 , Wojciech G Polak  1
Affiliations
Multicenter Study

Evaluation of Liver Graft Donation After Euthanasia

Marjolein van Reeven et al. JAMA Surg. .

Abstract

Importance: The option of donating organs after euthanasia is not well known. Assessment of the results of organ transplants with grafts donated after euthanasia is essential to justify the use of this type of organ donation.

Objectives: To assess the outcomes of liver transplants (LTs) with grafts donated after euthanasia (donation after circulatory death type V [DCD-V]), and to compare them with the results of the more commonly performed LTs with grafts from donors with a circulatory arrest after the withdrawal of life-supporting treatment (type III [DCD-III]).

Design, setting, and participants: This retrospective multicenter cohort study analyzed medical records and LT data for most transplant centers in the Netherlands and Belgium. All LTs with DCD-V grafts performed from the start of the donation after euthanasia program (September 2012 for the Netherlands, and January 2005 for Belgium) through July 1, 2018, were included in the analysis. A comparative cohort of patients who received DCD-III grafts was also analyzed. All patients in both cohorts were followed up for at least 1 year. Data analysis was performed from September 2019 to December 2019.

Exposures: Liver transplant with either a DCD-V graft or DCD-III graft.

Main outcomes and measures: Primary outcomes were recipient and graft survival rates at years 1, 3, and 5 after the LT. Secondary outcomes included postoperative complications (early allograft dysfunction, hepatic artery thrombosis, and nonanastomotic biliary strictures) within the first year after the LT.

Results: Among the cohort of 47 LTs with DCD-V grafts, 25 organ donors (53%) were women and the median (interquartile range [IQR]) age was 51 (44-59) years. Among the cohort of 542 LTs with DCD-III grafts, 335 organ donors (62%) were men and the median (IQR) age was 49 (37-57) years. Median (IQR) follow-up was 3.8 (2.1-6.3) years. In the DCD-V cohort, 30 recipients (64%) were men, and the median (IQR) age was 56 (48-64) years. Recipient survival in the DCD-V cohort was 87% at 1 year, 73% at 3 years, and 66% at 5 years after LT. Graft survival among recipients was 74% at 1 year, 61% at 3 years, and 57% at 5 years after LT. These survival rates did not differ statistically significantly from those in the DCD-III cohort. Incidence of postoperative complications did not differ between the groups. For example, the occurrence of early allograft dysfunction after the LT was found to be 13 (31%) in the DCD-V cohort and 219 (45%) in the DCD-III cohort. The occurrence of nonanastomotic biliary strictures after the LT was found to be 7 (15%) in the DCD-V cohort and 83 (15%) in the DCD-III cohort.

Conclusions and relevance: The findings of this cohort study suggest that LTs with DCD-V grafts yield similar outcomes as LTs with DCD-III grafts; therefore, grafts donated after euthanasia may be a justifiable option for increasing the organ donor pool. However, grafts from these donations should be considered high-risk grafts that require an optimal donor selection process and logistics.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr van Hoek reported receiving grants from Zambon Pharma, Astellas Pharma, and Chiesi Pharma and personal fees from Norgine outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Curve of Recipient Survival From Liver Graft Donation After Circulatory Death Type V (DCD-V) vs Type III (DCD-III)
DCD-III liver grafts were donated after a planned withdrawal of life-supporting treatments. DCD-V liver grafts were donated after euthanasia.
Figure 2.
Figure 2.. Kaplan-Meier Curve of Graft Survival in Recipients of Liver Graft Donation After Circulatory Death Type V (DCD-V) vs Type III (DCD-III)
DCD-III liver grafts were donated after a planned withdrawal of life-supporting treatments. DCD-V liver grafts were donated after euthanasia.
See this image and copyright information in PMC

Comment in

References

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