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ABSTRACT: Objectives
Outcomes of liver transplantations from donation after circulatory death (DCD) donors may be inferior to those achieved with donation after brain death (DBD) donors. The impact of using DCD donors is likely to depend on specific national practices. We compared risk-adjusted graft loss and recipient mortality after transplantation of DCD and DBD livers in the UK.Design
Prospective cohort study. Multivariable Cox regression and propensity score matching were used to estimate risk-adjusted HR.Setting
7 liver transplant centres in the National Health Service (NHS) hospitals in England and Scotland.Participants
Adults who received a first elective liver transplant between January 2005 and December 2010 who were identified in the UK Liver Transplant Audit.Interventions
Transplantation of DCD and DBD livers.Outcomes
Graft loss and recipient mortality.Results
In total, 2572 liver transplants were identified with 352 (14%) from DCD donors. 3-year graft loss (95% CI) was higher with DCD livers (27.3%, 21.8% to 33.9%) than with DBD livers (18.2%, 16.4% to 20.2%). After adjustment with regression, HR for graft loss was 2.3 (1.7 to 3.0). Similarly, 3-year mortality was higher with DCD livers (19.4%, 14.5% to 25.6%) than with DBD livers (14.1%, 12.5% to 16.0%) with an adjusted HR of 2.0 (1.4 to 2.8). Propensity score matching gave similar results. Centre-specific adjusted HRs for graft loss and recipient mortality seemed to differ among transplant centres, although statistical evidence is weak (p value for interaction 0.08 and 0.24, respectively).Conclusions
Graft loss and recipient mortality were about twice as high with DCD livers as with DBD livers in the UK. Outcomes after DCD liver transplantation may vary between centres. These results should inform policies for the use of DCD livers.
SUBMITTER: Callaghan CJ
PROVIDER: S-EPMC3773642 | biostudies-literature | 2013 Sep
REPOSITORIES: biostudies-literature
Callaghan Christopher J CJ Charman Susan C SC Muiesan Paolo P Powell James J JJ Gimson Alexander E AE van der Meulen Jan H P JH
BMJ open 20130903 9
<h4>Objectives</h4>Outcomes of liver transplantations from donation after circulatory death (DCD) donors may be inferior to those achieved with donation after brain death (DBD) donors. The impact of using DCD donors is likely to depend on specific national practices. We compared risk-adjusted graft loss and recipient mortality after transplantation of DCD and DBD livers in the UK.<h4>Design</h4>Prospective cohort study. Multivariable Cox regression and propensity score matching were used to esti ...[more]