American Surgical Association
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Expanding Deceased Donor Liver Availability by the Use of Donors After Cardiac Death
Robert M. Merion, MD, Shawn J. Pelletier, MD*, Nathan P. Goodrich, MS*, Michael J. Englesbe, MD*, Francis L. Delmonico, MD*
University of Michigan Medical School, Ann Arbor, MI, University of Michigan Medical School, Ann Arbor, MI, University Renal Research & Education Association, Ann Arbor, MI, University of Michigan Medical Schoool, Ann Arbor, MI, Harvard Medical School, Cambridge, MA

OBJECTIVE(S): Donation after cardiac death (DCD) has been used to increase the number of deceased donors and bridge the gap between limited organ supply and the pool of waiting list candidates. This study examines contemporary DCD practices and outcomes in liver transplantation.
METHODS: A national cohort of all DCD and donation after brain-death (DBD) liver transplants between 1/1/00 and 12/31/04 was identified in the Scientific Registry of Transplant Recipients. Time to graft failure (death or retransplant) was modeled by Cox regression, adjusted for relevant donor and recipient characteristics.
RESULTS: DCD livers were used for 472 (2%) of 24,070 transplants. Annual DCD liver activity increased from 39 in 2000 to 176 in 2004. Mean non-exception MELD scores for DCD recipients were significantly lower than for DBD recipients (18.6 vs 21.7; P<0.0001). The relative risk of DCD graft failure was 85% higher than for DBD recipients (adjusted hazard ratio=1.85, 95% confidence interval=1.51-2.26; P<0.001), corresponding to 3-month, 1-year, and 3-year graft survival rates of 83.0%, 70.1%, and 60.5%, respectively (vs. 89.2%, 83.0%, and 75.0% for DBD recipients). There was no significant effect of the level of transplant program experience with DCD donors on outcome.
CONCLUSIONS: The number of DCD livers used for transplant has increased rapidly in the last five years. However, DCD livers are associated with a significantly increased risk of graft failure unrelated to modifiable donor or recipient factors. Appropriate recipients for DCD livers have not been fully characterized and recipient informed consent should be obtained before use of these organs.

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