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Liver Transplantation Using Grafts from Donation After Cardiac Death Donors

  • Solid Organ Transplantation (C Sonnenday, Section Editor)
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Abstract

Utilization of liver grafts from donation after cardiac death donors has been proposed as a potential solution to the organ shortage for patients suffering from end-stage liver disease. The number of donation after cardiac death donors is likely to increase as a consequence of changing demographics and improvements in neurologic care. This potential has not been realized to full effect due to reports of inferior outcomes of liver transplantation using these grafts. In order to continue to provide excellent transplant care, it is critical to have an understanding of the factors necessary for successful use of liver grafts from donation after cardiac death donors. In this review, we will appraise the current understanding of the challenges involved in using these grafts, the critical recipient and donor considerations, and future directions.

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References

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  1. http://optn.transplant.hrsa.gov/converge/latestData/rptData.asp.

  2. http://srtr.transplant.hrsa.gov/annual_reports/2012/pdf/03_liver_13.pdf.

  3. Kramer AH, Zygun DA, Doig CJ, et al. Incidence of Neurologic death among patients with brain injury: a cohort study in a Canadian health region. CMAJ. 2013;185:838–45.

    Article  Google Scholar 

  4. Saidi RF, Bradley J, Greer D, et al. Changing pattern of organ donation at a single center: are potential brain dead donors being lost to donation after cardiac death? Am J Transplant. 2010;10:2536–40.

    Article  CAS  PubMed  Google Scholar 

  5. Bendorf A, Kelly PJ, Kerridge IH, et al. An international comparison of the effect of policy shifts to organ donation following cardiocirculatory death on donation rates after brain death and transplantation rates. PLos One. 2013;8:e62010.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Lee DD, Croome KP, Perry KP, Burns JM, Nguyen JH, Keaveny AP, Taner CB. Liver transplanation at Mayo Clinic Florida. In: Terasaki PI, Cecka JM, editors. Clinical transplants 2014. Los Angeles: Terasaki Foundation Laboratory (in press).

  7. Merion RM, Pelletier SJ, Goodrich N, Englesbe MJ, Delmonico FL. Donation after cardiac death as a strategy to increase deceased donor liver availability. Ann Surg. 2006;244(4):555–62.

    PubMed Central  PubMed  Google Scholar 

  8. Abt PL, Desai NM, Crawford MD, et al. Survival following liver transplantation from non-heart-beating donors. Ann Surg. 2004;239(1):87–92.

    Article  PubMed Central  PubMed  Google Scholar 

  9. •• Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant. 2006;6(4):791–6. Excellent analysis of UNOS data establishing the critical donor factors considered to determine a “low risk” DCD donor.

  10. • Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, et al. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005;242(5):724–31. Early single center experience demonstrating the challenges and increased complications associated with DCD grafts.

  11. Skaro AI, Jay CL, Baker TB, Wang E, Pasricha S, Lyuksemburg V, Martin JA, Feinglass JM, Preczewski LB, Abecassis MM. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery. 2009;146:543–52 discussion 552–553.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Pine JK, Aldouri A, Young AL, et al. Liver transplantation following donation after cardiac death: an analysis using matched pairs. Liver Transpl. 2009;15(9):1072–82.

    Article  PubMed  Google Scholar 

  13. de Vera ME, Lopez-Solis R, Dvorchik I, et al. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant. 2009;9(4):773–81.

    Article  PubMed  Google Scholar 

  14. Manzarbeitia CY, Ortiz JA, Jeon H, Rothstein KD, Martinez O, Araya VR, Munoz SJ, Reich DJ. Long-term outcome of controlled, non-heart-beating donor liver transplantation. Transplantation. 2004;78(2):211–5.

    Article  PubMed  Google Scholar 

  15. Abt P, Crawford M, Desai N, Markmann J, Olthoff K, Shaked A. Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications. Transplantation. 2003;75(10):1659–63.

    Article  PubMed  Google Scholar 

  16. Fujita S, Mizuno S, Fujikawa T, et al. Liver transplantation from donation after cardiac death: a 55527717 single center experience. Transplantation. 2007;84(1):46–9.

    Article  PubMed  Google Scholar 

  17. • Chan EY, Olson LC, Kisthard JA, Perkins JD, Bakthavatsalam R, Halldorson JB, Reyes JD, Larson AM, Levy AE. Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors. Liver Transpl. 2008;14:604–10. Early single center report demonstrating favorable outcomes in DCD liver, among the first reports to do so.

  18. Muiesan P, Girlanda R, Jassem W, Melendez HV, O’Grady J, Bowles M, Rela M, Heaton N. Single-center experience with liver transplantation from controlled non-heart beating donors: a viable source of grafts. Ann Surg. 2005;242(5):732–8.

    Article  PubMed Central  PubMed  Google Scholar 

  19. DeOliveira ML, Jassem W, Valente R, Khorsandi SE, Santori G, Prachalias A, Srinivasan P, Rela M, Heaton N. Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center. Ann Surg. 2011;254(5):716–22.

    Article  PubMed  Google Scholar 

  20. Nguyen JH, Bonatti H, Dickson RC, Hewitt WR, Grewal HP, Willingham DL, Harnois DM, Schmitt TM, Machicao VI, Ghabril MS, Keaveny AP, Aranda-Michel J, Satyanarayana R, Rosser BG, Hinder RA, Steers JL, Hughes CB. Long-term outcomes of donation after cardiac death liver allografts from a single center. Clin Transpl. 2009;23(2):168–73.

    Article  Google Scholar 

  21. Dubbeld J, Hoekstra H, Farid W, Ringers J, Porte RJ, Metselaar HJ, Baranski AG, Kazemier G, van den Berg AP, van Hoek B. Similar liver transplantation survival with selected cardiac death donors and brain death donors. Br J Surg. 2010;97:744–53.

    Article  CAS  PubMed  Google Scholar 

  22. Hashimoto K, Eghtesad B, Gunasekaran G, Fujiki M, Uso TD, Quintini C, et al. Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors. Am J Transpl. 2010;10:2665–72.

    Article  CAS  Google Scholar 

  23. Lee DD, Singh A, Burns JM, Perry DK, Nguyen JH, Taner CB. Early allograft dysfunction in liver transplantation with donation after cardiac death donors results in inferior survival. Liver Transpl. 2014;20(12):1447–53.

    PubMed  Google Scholar 

  24. Grewal HP, Willingham DL, Nguyen J, Hewitt WR, Taner BC, Cornell D, Rosser BG, Keaveny AP, Aranda-Michel J, Satyanarayana R, Harnois D, Dickson RC, Kramer DJ, Hughes CB. Liver transplantation using controlled donation after cardiac death donors: an analysis of a large single-center experience. Liver Transpl. 2009;15(9):1028–35.

    Article  PubMed  Google Scholar 

  25. Lee KW, Simpkins CE, Montgomery RA, Locke JE, Segev DL, Maley WR. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation. 2006;82:1683–8.

    Article  PubMed  Google Scholar 

  26. Perry DK, Willingham DL, Sibulesky L, Bulatao IG, Nguyen JH, Taner CB. Should donation after cardiac death liver grafts be used for retransplantation? Ann Hepatol. 2011;10(4):482–5.

    PubMed  Google Scholar 

  27. Taner CB, Bulatao IG, Arasi LC, Perry DK, Willingham DL, Sibulesky L, Rosser BG, Canabal JM, Nguyen JH, Kramer DJ. Liver transplantation in the critically ill: donation after cardiac death compared to donation after brain death grafts. Ann Hepatol. 2012;11(5):679–85.

    PubMed  Google Scholar 

  28. Sibulesky L, Heckman MG, Taner CB, Canabal JM, Diehl NN, Perry DK, Willingham DL, Pungpapong S, Rosser BG, Kramer DJ, Nguyen JH. Outcomes following liver transplantation in intensive care unit patients. World J Hepatol. 2013;5(1):26–32.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Wadei HM, Bulatao IG, Gonwa TA, Mai ML, Prendergast M, Keaveny AP, Rosser BG, Taner CB. Inferior long-term outcomes of liver-kidney transplantation using donation after cardiac death donors: single-center and organ procurement and transplantation network analyses. Liver Transpl. 2014;20(6):728–35.

    Article  PubMed  Google Scholar 

  30. Mathur AK, Heimbach J, Steffick DE, Sonnenday CJ, Goodrich NP, Merion RM. Donation after cardiac death liver transplantation: predictors of outcome. Am J Transplant. 2010;10(11):2512–9.

    Article  CAS  PubMed  Google Scholar 

  31. Hong JC, Yersiz H, Kositamongkol P, Xia VW, Kaldas FM, Petrowsky H, Farmer DG, Lipshutz G, Markovic D, Hiatt JR, Busuttil RW. Liver transplantation using organ donation after cardiac death: a clinical predictive index for graft failure-free survival. Arch Surg. 2011;146(9):1017–23.

    Article  PubMed  Google Scholar 

  32. Hernandez-Alejandro R, Croome KP, Quan D, Mawardi M, Chandok N, Dale C, McAlister V, Levstik MA, Wall W, Marotta P. Increased risk of severe recurrence of hepatitis C virus in liver transplant recipients of donation after cardiac death allografts. Transplantation. 2011;92(6):686–9.

    Article  PubMed  Google Scholar 

  33. Taner CB, Bulatao IG, Keaveny AP, Willingham DL, Pungpapong S, Perry DK, Rosser BG, Harnois DM, Aranda-Michel J, Nguyen JH. Use of liver grafts from donation after cardiac death donors for recipients with hepatitis C virus. Liver Transpl. 2011;17(6):641–9.

    Article  PubMed  Google Scholar 

  34. Tao R, Ruppert K, Cruz RJ Jr, Malik SM, Shaikh O, Ahmad J, DiMartini A, Humar A, Fontes PA, de Vera ME. Hepatitis C recurrence is not adversely affected by the use of donation after cardiac death liver allografts. Liver Transpl. 2010;16(11):1288–95.

    Article  PubMed  Google Scholar 

  35. Croome KP, Wall W, Chandok N, Beck G, Marotta P, Hernandez-Alejandro R. Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts. Liver Transpl. 2013;19(11):1214–23.

    Article  PubMed  Google Scholar 

  36. Croome KP, Lee DD, Paz D, Burns JM, Nguyen JH, Perry DK, Harnois DM, Taner CB. The use of donation after cardiac death allografts does not increase recurrence of hepatocellular carcinoma. Am J Transplant. 2015. doi:10.1111/ajt.13306.

    PubMed  Google Scholar 

  37. Institute of Medicine, National Academy of Sciences. Non-heart-beating organ transplantation: Medical and ethical issues in procurement. Washington: National Academy Press; 1997.

    Google Scholar 

  38. Bernat JL, D’Alessandro AM, Port FK, Bleck TP, Heard SO, Medina J, Rosenbaum SH, Devita MA, Gaston RS, Merion RM, Barr ML, Marks WH, Nathan H, O’connor K, Rudow DL, Leichtman AB, Schwab P, Ascher NL, Metzger RA, Mc Bride V, Graham W, Wagner D, Warren J, Delmonico FL. Report of a national conference on donation after cardiac death. Am J Transplant. 2006;6(2):281–91.

    Article  CAS  PubMed  Google Scholar 

  39. Halazun KJ, Al-Mukhtar A, Aldouri A, Willis S, Ahmad N. Warm ischemia in transplantation: search for a consensus definition. Transplant Proc. 2007;39(5):1329–31.

    Article  CAS  PubMed  Google Scholar 

  40. Kootstra G, Daemen JHC, Oomen APA. Categories of non-heart beating donors. Transpl Proc. 1995;27:2893–4.

    CAS  Google Scholar 

  41. Algahim MF, Love RB. Donation after circulatory death: the current state and technical approaches to organ procurement. Curr Opin Organ Transplant. 2015;20(2):127–32.

    Article  PubMed  Google Scholar 

  42. Seal JB, Bohorquez H, Reichman T, Kressel A, Ghanekar A, Cohen A, McGilvray ID, Cattral MS, Bruce D, Greig P, Carmody I, Grant D, Selzner M, Loss G. Thrombolytic protocol minimizes ischemic-type biliary complications in liver transplantation from donation after circulatory death donors. Liver Transpl. 2015;21(3):321–8.

    Article  PubMed  Google Scholar 

  43. •• Taner CB, Willingham DL, Perry DK, Keaveny AP, Nguyen JH, et al. Events in procurement as risk factors for ischemic cholangiopathy in liver transplantation using donation after cardiac death donors. Liver Transpl. 2012;18:101–11. This article defined our approach to the DCD donor during procurement and identified the critical time interval between asystole to cross clamp.

  44. Taner CB, Bulatao IG, Perry DK, Sibulesky L, Willingham DL, Kramer DJ, Nguyen JH. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int. 2012;25(8):838–46.

    Article  PubMed  Google Scholar 

  45. op den Dries S, Karimian N, Sutton ME, Westerkamp AC, Nijsten MW, Gouw AS, Wiersema-Buist J, Lisman T, Leuvenink HG, Porte RJ. Ex vivo normothermic machine perfusion and viability testing of discarded human donor livers. Am J Transplant. 2013;13(5):1327–35. doi:10.1111/ajt.12187 Epub 2013 Mar 6.

    Article  CAS  PubMed  Google Scholar 

  46. Guarrera J, Herny S, Samstein B, et al. Hypothermic machine preservation facilitates successful transplantation of “orphan” extended criteria donor livers. Am J Transplant. 2015;15(1):161–9.

    Article  CAS  PubMed  Google Scholar 

  47. Ravikumar R, Coussios CC, Holroyd D, Heaton N, Friend PJ, Jassem W. 2014. Human liver transplantation using normothermic machine preservation. http://www.abstracts2view.com/ilts/view.php?nu=ILTS14L1_O-1&terms. Accessed 9 Nov 2014.

  48. Fontes P, Lopez R, van der Plaats A, Vodovotz Y, Minervini M, Scott V, Soltys K, Shiva S, Paranjpe S, Sadowsky D, Barclay D, Zamora R, Stolz D, Demetris A, Michalopoulos G, Marsh JW. Liver preservation with machine perfusion and a newly developed cell-free oxygen carrier solution under subnormothermic conditions. Am J Transplant. 2015;15(2):381–94.

    Article  CAS  PubMed  Google Scholar 

  49. Magliocca JF, Magee JC, Rowe SA, et al. Extracorporeal support for organ donation after cardiac death effectively expands the donor pool. J Trauma. 2005;58:1095–102.

    Article  PubMed  Google Scholar 

  50. Rojas-Pena A, Sall LE, Gravel MT, et al. Donation after circulatory determination of death: The University of Michigan experience with extracorporeal support. Transplantation. 2014;98:328–34.

    Article  PubMed  Google Scholar 

  51. Yamauchi JI, Richter S, Vollmar B, Menger MD, Minor T. Warm preflush with streptokinase improves microvascular procurement and tissue integrity in liver graft retrieval from non-heart-beating donors. Transplantation. 2000;69:1780–4.

    Article  CAS  PubMed  Google Scholar 

  52. D’Alessandro AM, Fernandez LA, Chin LT, et al. Donation after cardiac death: The University of Wisconsin experience. Ann Transplant. 2004;9:68–71.

    PubMed  Google Scholar 

  53. Maheshwari A, Maley W, Li Z, Thuluvath PJ. Biliary complications and outcomes of liver transplantation from donors after cardiac death. Liver Transpl. 2007;13(12):1645–53.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Transplantation, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    David D. Lee, Hector Saucedo-Crespo & C. Burcin Taner

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  1. David D. Lee
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  2. Hector Saucedo-Crespo
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  3. C. Burcin Taner
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Correspondence to C. Burcin Taner.

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This article is part of the Topical Collection on Solid Organ Transplantation.

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Lee, D.D., Saucedo-Crespo, H. & Taner, C.B. Liver Transplantation Using Grafts from Donation After Cardiac Death Donors. Curr Surg Rep 3, 26 (2015). https://doi.org/10.1007/s40137-015-0105-2

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