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Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory Death Liver Transplantation in the United Kingdom?
Author(s) -
Boteon Amanda P. C. S.,
Schlegel Andrea,
Kalisvaart Marit,
Boteon Yuri L.,
Abradelo Manuel,
Mergental Hynek,
Roberts J. Keith,
Mirza Darius F.,
Perera M. Thamara P. R.,
Isaac John R.,
Muiesan Paolo
Publication year - 2019
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.25410
Subject(s) - medicine , donation , liver transplantation , transplantation , hepatectomy , surgery , retrospective cohort study , risk assessment , multivariate analysis , computer security , resection , computer science , economics , economic growth
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.