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First experience of liver transplantation with type 2 donation after cardiac death in F rance
Author(s) -
Savier Eric,
Dondero Federica,
Vibert Eric,
Eyraud Daniel,
Brisson Hélène,
Riou Bruno,
Fieux Fabienne,
NailiKortaia Salima,
Castaing Denis,
Rouby JeanJacques,
Langeron Olivier,
Dokmak Safi,
Hannoun Laurent,
Vaillant JeanChristophe
Publication year - 2015
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24107
Subject(s) - medicine , interquartile range , liver transplantation , organ donation , surgery , transplantation , cause of death , disease
Organ donation after unexpected cardiac death [type 2 donation after cardiac death (DCD)] is currently authorized in France and has been since 2006. Following the Spanish experience, a national protocol was established to perform liver transplantation (LT) with type 2 DCD donors. After the declaration of death, abdominal normothermic oxygenated recirculation was used to perfuse and oxygenate the abdominal organs until harvesting and cold storage. Such grafts were proposed to consenting patients < 65 years old with liver cancer and without any hepatic insufficiency. Between 2010 and 2013, 13 LTs were performed in 3 French centers. Six patients had a rapid and uneventful postoperative recovery. However, primary nonfunction occurred in 3 patients, with each requiring urgent retransplantation, and 4 early allograft dysfunctions were observed. One patient developed a nonanastomotic biliary stricture after 3 months, whereas 8 patients showed no sign of ischemic cholangiopathy at their 1‐year follow‐up. In comparison with a control group of patients receiving grafts from brain‐dead donors (n = 41), donor age and cold ischemia time were significantly lower in the type 2 DCD group. Time spent on the national organ wait list tended to be shorter in the type 2 DCD group: 7.5 months [interquartile range (IQR), 4.0‐11.0 months] versus 12.0 months (IQR, 6.8‐16.7 months; P = 0.08. The 1‐year patient survival rates were similar (85% in the type 2 DCD group versus 93% in the control group), but the 1‐year graft survival rate was significantly lower in the type 2 DCD group (69% versus 93%; P = 0.03). In conclusion, to treat borderline hepatocellular carcinoma, LT with type 2 DCD donors is possible as long as strict donor selection is observed. Liver Transpl 21:631‐643, 2015 . © 2015 AASLD.