Back to Search
Start Over
Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory Death Liver Transplantation in the United Kingdom?
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2019 Apr; Vol. 25 (4), pp. 545-558. - Publication Year :
- 2019
-
Abstract
- Parameters of retrieval surgery are meticulously documented in the United Kingdom, where up to 40% of livers are donation after circulatory death (DCD) donations. This retrospective analysis focuses on outcomes after transplantation of DCD livers, retrieved by different UK centers between 2011 and 2016. Donor and recipient risk factors and the donor retrieval technique were assessed. A total of 236 DCD livers from 9 retrieval centers with a median UK DCD risk score of 5 (low risk) to 7 points (high risk) were compared. The majority used University of Wisconsin solution for aortic flush with a median hepatectomy time of 27-44 minutes. The overall liver injury rate appeared relatively high (27.1%) with an observed tendency toward more retrieval injuries from centers performing a quicker hepatectomy. Among all included risk factors, the UK DCD risk score remained the best predictor for overall graft loss in the multivariate analysis (P < 0.001). In high-risk and futile donor-recipient combinations, the occurrence of liver retrieval injuries had negative impact on graft survival (P = 0.023). Expectedly, more ischemic cholangiopathies (P = 0.003) were found in livers transplanted with a higher cumulative donor-recipient risk. Although more biliary complications with subsequent graft loss were found in high-risk donor-recipient combinations, the impact of the standardized national retrieval practice on outcomes after DCD liver transplantation was minimal.<br /> (Copyright © 2018 by the American Association for the Study of Liver Diseases.)
- Subjects :
- Adenosine pharmacology
Adult
Aged
Allografts blood supply
Allografts drug effects
Allografts surgery
Allopurinol pharmacology
Female
Glutathione pharmacology
Graft Survival
Hepatectomy adverse effects
Hepatectomy methods
Hepatectomy standards
Humans
Insulin pharmacology
Liver blood supply
Liver drug effects
Liver surgery
Male
Middle Aged
Operative Time
Organ Preservation methods
Organ Preservation standards
Organ Preservation statistics & numerical data
Organ Preservation Solutions pharmacology
Practice Guidelines as Topic
Practice Patterns, Physicians' standards
Raffinose pharmacology
Retrospective Studies
Risk Assessment
Risk Factors
Tissue Donors
Tissue and Organ Procurement methods
Tissue and Organ Procurement standards
United Kingdom epidemiology
Graft Rejection epidemiology
Hepatectomy statistics & numerical data
Liver Transplantation adverse effects
Practice Patterns, Physicians' statistics & numerical data
Tissue and Organ Procurement statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6473
- Volume :
- 25
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 30919560
- Full Text :
- https://doi.org/10.1002/lt.25410