Donation after cardio-circulatory death liver transplantation

Table 1 Risk classification for donation after cardio-circulatory death donors and donation after cardio-circulatory death-liver transplantations recipients

Authors		Donors	Recipients
Mateo et al[74]	Low risk	Both WIT ≤ 30 min and CIT ≤ 10 h	RCRR ≤ 1.5
	High risk	WIT > 30 min and/or CIT > 10 h	RCRR > 1.5
			Re-transplantation and/or
			On life-support and/or
			A combination of ≥ 3 risk factors:
			Hospitalization or in an intensive care unit
			Serum creatinine > 2 mg/dL
			On dialysis
			Age > 60 yr
Lee et al[32]	Low risk	Donors with no identified donor risk factors	Recipients with no identified recipient risk factors
	High risk	Donors with at least one identified donor risk factor:	Recipients with at least one identified recipient risk factor:
		Donor age > 45 yr	Previous transplantation
		WIT > 15 min	Life support at transplantation
		CIT > 10 h
de Vera et al[34]	Low risk	-	MELD scores ≤ 30
	High risk	-	MELD scores > 30
			On life support (mechanical ventilation, hemodialysis)

RCRR: Recipient cumulative relative risk; WIT: Warm ischemia time; CIT: Cold ischemic time; MELD: Model for end-stage liver disease.

Table 2 Results of donation after cardio-circulatory death-liver transplantations in single-center studies

Authors study period	Transplant center	Publication year	Patient number and Maastricht category	WIT (min)	CIT (min)	Mean follow-up	PNF %	Major biliary complications %	ITBL %	HAT %	HAS %	Rejection %	Retransplan-tation %	Graft survival %				Patient survival %
														1 yr	3 yr	5 yr	10 yr	1 yr	3 yr	5 yr	10 yr
Casavilla et al[85] 1989-1993	Pittsburgh, United States	1995	6 DCD4	37	10.6 h	-	501	-	-	16.6	-	-	83.3	17	-	-	-	67	-	-	-
			6 DCDc	23.8	11 h	-	01	-	-	33.3	-	-	33.3	50	-	-	-	50	-	-	-
Otero et al[87] 1995-2000	Madrid, Spain	2003	20 DCD2	10	647	> 2 yr	251	301	-	0	-	27	25	80	-	-	-	80	-	-	-
			40 DBD	8	405	-	31	81	-	-	-	34	5	55	-	-	-	83	-	-	-
Quintela et al[86] 1995-2004	Spain	2005	9 DCD2 + 1 DCD4	80	561	-	10	-	-	-	-	-	10	100	-	-	-	100	-	-	-
Suárez et al[89] 1994-2005	Spain	2008	27 DCD2	13	635	> 3 mo	181	41.71	25.01	3.6	-	17.4	-	-	-	491	-	-	-	62	-
			471 DBD	7	-	-	31	16.81	2.31	3.1	-	28.6	-	-	-	681	-	-	-	74	-
Fondevila et al[29] 2002-2006	Barcelona, Spain	2007	10 DCD1	-	399	-	10	10	-	10	-	-	20	50	-	-	-	70	-	-	-
			20 DBD	-	-	-	0	0	-	5	-	-	5	75	-	-	-	80	-	-	-
Jiménez-Galanes et al[71] 2006-2008	Madrid, Spain	2009	20 DCD2	12	432	360 d	10	5	50	0	-	-	11	80	-	-	-	85.5	-	-	-
			40 DBD	6	409	-	2.5	-	-	-	-	-	501	87.5	-	-	-	87.5	-	-	-
Pine et al[72] 2002-2008	St. James, London, United Kingdom	2009	39 DCDc	13.4	352	2.5 yr	5.1	33.31	20.51	2.6	12.81	20.5	7.61	79.51	63.61	-	-	801	68.21	-	-
			39 DBD	-	593	6.6 yr	-	10.21	-	5.1	-	23.1	2.51	97.41	97.41	-	-	1001	11	-	-
de Vera et al[34] 1993-2007	Pittsburgh, United States	2009	141 DCDc	19.8	657	-	121	251	16.31	66	-	-	181	691	-	561	441	79	-	70	57
			282 DBD	-	636	-	31	131	< 11	-	-	-	71	821	-	731	631	85	-	76	64
Yamamoto et al[90] 1984-1988	Stockholm, Sweden	2010	24 DCDc	6	7 h	> 20 yr	8.3	37.51	-	33.31	-	70.8	-	54.2	-	37.5	37.5	61.9	-	42.9	42.9
			16 DBD	-	6.8 h	> 20 yr	18.7	6.31	-	-	-	56.2	-	43.8	-	37.5	37.5	63.6	-	-	54.5
Fujita et al[105] 1990-2006	Gainesville, Floria, United States	2007	24 DCDc	12.8	7.6 h	-	2.8	25	12.5	8.3	-	39.1	20.8	69.1	58.6	-	-	86.8	81.7	-	-
			1209 DBD	-	8.1 h	-	-	20.5	-	4.1	-	-	9.4	78.7	70.2	-	-	84	76	-	-
Foley et al[91] 1993-2002	Wisconsin, United States	2005	36 DCDc	17.8	8.2 h	3 yr	5.5	331	13.8	5.5	16.61	61	19.41	671	561	-	-	801	681	-	-
			553 DBD	-	8.3 h	4.6 yr	1.3	101	8	11.8	5.41	56	71	861	801	-	-	911	841	-	-
Manzarbeitia et al[106] 1995-2002	Philadelphia, United States	2004	19 DCDc	19.6	574	1000 d	5.2	10.5	-	-	-	-	10.5	-	-	-	-	89.5	-	-	-
			311 DBD	-	557	-	-	13.8	-	-	-	-	8.7	-	-	-	-	84.2	-	-	-
Abt et al[104] 1996-2001	Pennsylvania, United States	2003	15 DCDc	20.4	366	819 d	6.7	33.31	26.71	3.2	-	20	6.61	71.8	71.8	-	-	79	79	-	-
			221 DBD	-	464	690 d	3.6	9.51	2.31	-	-	21.3	3.61	85.4	73.9	-	-	90.9	77.7	-	-
Nguyen et al[45] 1998-2001	Mayo Clinic, Floria, United States	2009	19 DCDc	16	6.7 h	> 4.5 yr	5.3	26.3	10.5	0	5.3	5.31	15.8	73.7	68.4	63.2	-	89.5	89.5	89.5	-
			234 ECD	-	7.1 h	-	4.7	22.6	-	-	-	33.31	8.51	-	-	-	-	85	78.6	72.3	-
			214 SCD	-	7.5 h	-	1.7	15.9	-	-	-	33.21	19.61	-	-	-	-	84.3	80.7	76.5	-

DCDc: Controlled donors after cardiac death; DCD₁, DCD₂ and DCD₄: Maastricht category-1, category-2 and category-4 DCD donors; DBD: Donors after brain death; SCD: Standard criteria donors; ECD: Extended criteria donors; WIT: Warm ischemia time; CIT: Cold ischemia time; PNF: Primary non-function; ITBL: Ischemic-type biliary lesions; HAT: Early hepatic artery thrombosis; HAS: Early hepatic artery stenosis. Major symptomatic biliary complications include biliary leak, anastomotic and non-anastomotic stenosis.

¹Numbers denote the statistically significant difference between groups.

Table 3 Results of donation after cardio-circulatory death- liver transplantations in single-center studies

Authors study period	Transplant center	Publication year	Patient number and Maastricht category	WIT (min)	CIT (min)	Mean follow-up	PNF %	Major biliary complications %	ITBL %	HAT %	HAS %	Rejection %	Retransplantation %	Graft survival %			Patient survival %
														1 yr	3 yr	5 yr	1 yr	3 yr	5 yr
Grewal et al[20] 1998-2006	Mayo Clinic, Floria, United States	2009	108 DCDc	22.3 -	6.3 h	- -	3.7	- -	8.31	0.9	- -	- -	14.8	79.3	74.5	71	91.5	88.1	88.1 77.2
			1328 DBD		7.1 h		1.4		1.91	1.7			9.3	81.6	74.7	69.1	87.3	81.1
Kaczmarek et al[41] 1999-2006		2007	11 DCDc	34.6 -	7.6 h	> 14 mo -	0	45.41	11	0	- -	- -	9.11 01	- -	- -	- -	- -	- -	- -
			164 DBD		-		-	16.41	8.21	-
Dubbeld et al[51] 2001-2006		2010	55 DCDc	16.5 -	456	- -	2	281	241	74.7 -	- -	- -	18	74	68	- -	85	80	- -
			471 DBD		515		1.5	8.31	7.91				10.4	80.4	74.5		86.3	80.8
Chan et al[43] 2003-2006	Seattle, United States	2008	51 DCDc	- -	-	3 yr	0 3.3	23.51	13.71	4.8 -	- -	- -	9.8	79	79	- -	83	83	- -
			334 DBD			-		8.91	1.21				-	85	77		88	78
Skaro et al[36] 2003-2008	Chicago, United States	2009	32 DCDc	15.8 -	5.5 h	- -	3	531	381	93 -	- -	- -	21	611	531	- -	74	74	- -
			237 DBD		5.2 h		1	221	21				271	851	741		90	81
Jay et al[107] 2004-2008	Chicago, United States	2010	28 DCDc	16.5 -	5.7 h	1.8 yr	3.6	57.71	441	10.7	7.1	- -	21.41	601	501	- -	701	701	- -
			198 DBD		5.3 h	-	0.5	211	1.61	3	6.1		7.11	891	781		961	931
Dezza et al[92] 2003 -2006	Ghent, Belgium	2007	13 DCDc	10 -	6.16 h	163 d	81	- -	23.11	- -	- -	- -	311	541	- -	- -	621	- -	- -
			98 DBD		9.14 h	603 d	11		-				121	791			861
Maheshwari et al[95] 1997-2006	Johns Hopkins Baltimore, United States		20 DCDc	33	8.7 h	-	5	60	50	5	-	-	20	62	62	30	78	78	40
Muiesan et al[70] 2001-2004	London, United Kingdom	2005	31 DCDc	14.7	8.6 h	-	3.1	9.4	0	3.1	-	28.1	3.1	86.5	-	-	89.6	-	-
Abou Abbass et al[97] 2004-2008	United States	2010	26 DCDc	39	5.3 h	-	0	46	15.4	11.5	7.7	26.9	23	77	-	-	92	-	-
Detry et al[94] 2003-2007		2010	58 DCDc	25	451	-	3.4	38	32.7	3.4	3.4	-	13.8	72.4	48.8	-	83.3	66.9	-
Hernandez-Alejandro et al[42] 2006-2007	London, United Kingdom	2010	10 DCDc	54.7	5.8 h	-	10	10	0	0	0	-	10	-	-	-	-	-	-
Hashimoto et al[96] 2005-2009	United States	2010	22 DCDc	21	422	-	4.5	27	9	0	0	-	9	81	81	-	-	-	-

DCDc: Controlled donors after cardiac death; DBD: Donors after brain death; SCD: Standard criteria donors; ECD: Extended criteria donors; WIT: Warm ischemia time; CIT: Cold ischemia time; PNF: Primary non-function; ITBL: Ischemic-type biliary lesions; HAT: Early hepatic artery thrombosis; HAS: Early hepatic artery stenosis. Major symptomatic biliary complications include biliary leak, anastomotic and non-anastomotic stenosis.

¹Numbers denote the statistically significant difference between groups.

Table 4 Results of donation after cardio-circulatory death-liver transplantations in United Network for Organ Sharing data base registry

Authors and study period	Publication year	Patient number and Maastricht category	WIT (min)	CIT (h)	PNF (%)	Retransplantation (%)	Graft survival %			Patient survival %
							1 yr	3 yr	5 yr	1 yr	3 yr	5 yr
Abt et al[67] 1993-2001	2004	144 DCD	12.7	8.1	11.81	13.91	70.21	63.31	-	79.7	72.1	-
		26 856 DBD		8.9	6.41	8.31	80.41	72.11		85	77.4
Mateo et al[74] 1996-2003	2006	367 DCD	15.6	8.3	-	-	711	601	531	-	-	-
		33 111 DBD		8.4			801	721	651
Lee et al[32] 1996-2006	2006	874 DCD	15.4	7.9	-	-	72.11	61.81	38.81	82.31	75.91	65.31
		43 734 DBD		8.2			80.71	71.91	65.61	85.41	77.51	71.51
Doshi et al[68] 1998-2004	2007	345 DCD	-	8.2	6.41	13.01	75	65	-	83	77	-
		20 289 young-DBD		8.1	3.91	5.61	831	751		881	801
		3604 old-DBD		8.2	5.31		76	64		83	73
Merion et al[125] 2000-2004	2006	472 DCD	-	7.9	-	-	70.11	60.51	-	-	-	-
		23 598 DBD		8.1			831	751
Selck et al[69] 2002-2007	2008	855 DCD	-	-	-	21.61	73.81	57.61	-	-	-	-
		21 089 DBD				8.81	84.41	74.41
Mathur et al[127] 2001-2009	2010	1567 DCD	16.1	7.5	-	13.6	-	-	-	78	64.9	-

DCD: Donors after cardiac death; DBD: Donors after brain death; WIT: Warm ischemia time; CIT: Cold ischemia time; PNF: Primary non-function. Major symptomatic biliary complications include biliary leak, anastomotic and non-anastomotic stenosis.

¹Numbers denote the statistically significant difference between groups.