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Oral Presentations

Session Title: Parallel Session: LIVER TRANSPLANTATION
Presentation Date: 31 MAR, 2011

LIVER TRANSPLANTATION AFTER CARDIAC DEATH DONATION: SINGLE-CENTRE LONG-TERM RESULTS

W. Jassem*, R. Valente, D. Chasiotis, S. Khorsandi, T. Cherian, H. Vilca Melendez, A. Prachalias, P. Srinivasan, M. Heneghan, M. Rela, N. Heaton
Institute of Liver Studies-King's College London School of Medicine at King's College Hospital, London, UK. *wayel.jassem@kcl.ac.uk

The shortage of organs has promoted the use of donation after cardiac death (DCD) organs with the aim of expanding the donor pool. However, there are concerns regarding short and long-term outcomes. In the current study we describe our experience of using DCD allografts.
Material and methods: The present study is a single centre retrospective analysis of DCD liver transplantation series between 2001 and 2010.
Results: Between May 2001 and October 2010, 186 DCD allografts were used. The median age of donors was 40 (8 - 79) years and donor warm ischemia time was 15.5 (7 - 31) minutes. The median cold ischemia time was 7.5 (4 - 15) hours. Sixteen allografts were mildly steatotic and three were moderately fatty on histology. There were 54 female and 132 male recipients with a median MELD score of 15 (4-41). There were 19 paediatric recipients aged between 1-16 years. Most recipients' diagnosis was of non-cholestatic cirrhosis. The majority of the recipients were stable and were admitted for from home. However, 33 patients were inpatient and 9 were in Intensive Care Unit at time of transplant.
Seven patients (3.7%) had primary non-function. Median follow-up was 24 (1 - 116) months. Twenty-one patients died and 31 grafts were lost. The overall actuarial patient (graft) survival at 1, 3 and 5 years was 89.9% (85.8%), 85.6% (80.8%) and 83.6% (76.6%). Four (2.3%) patients developed diffuse primary ischemic cholangiopathy, which were severe in 2 and mild in 2. None of these patients required re-transplantation. Biopsy proven rejection occurred in 43 (25.1%) cases, all responded to steroid therapy. Median hospital stay was 18 (7 - 163) days.
Day 5 INR and Bilirubin were found to be associated with the occurrence of PNF (p≤0.05). Additionally, a direct association was found between donor warm ischemia time and cholangiopathy (p≤0.05).
Conclusions: The short- and long-term outcomes of DCD allografts is satisfactory. However, the DCD programme requires significant effort and resources. Careful matching of donors and recipients is mandatory and further research in the field of ischemia / reperfusion is necessary to improve outcome.