Hemoderivates Transfusion Differences Between Recipients of Liver Grafts from Donors After Uncontrolled Cardiac Death (uDCD) and Brain Death Donors (DBD)
Iago Justo 1, Pilar Del Pozo1, Maria García-Conde1, Anisa Nutu1, Alberto Marcacuzco1, Oscar Caso1, Isabel Lechuga1, Marina Perez-Flecha1, Alvaro García-Sesma1, Jorge Calvo1, Alejandro Manrique1, Felix Cambra1, Satiago Salamea1, Carlos Jimenez-Romero1.
1General Surgery, "12 de Octubre" U. H., Madrid, Spain
Introduction: The scarcity of grafts for liver transplantation (LT) from brain death donors (BDD), as well as the increasing mortality on waiting list have led us to look for other alternatives to achieve more liver grafts, being those from controlled and uncontrolled cardiac death (uDCD) the most attractive sources. However, intraoperative bleeding during LT has been higher when using uDCD donors, also related with higher morbi-mortality and lower patient and graft survival. Our aim is to compare the necessity of hemoderivates in uDCD and DBD groups.
Materials and Methods: Between January 2006 and December 2016 we performed 783 LT in adult recipients, excluding retransplants or patients undergoing OLT for acute liver failure. Liver grafts from uDCD donors (Group A) were used in 75 patients, and livers from BDD donors (Group B) were used in 708 patients.
Results: The mean age in group A was 59±8 years vs B 55±10 years in Group B (p=0.000). There were no significant differences in terms of sex, BMI and Child score. HCV cirrhosis was the indication for LT in 60% of cases in Group A vs 50.2% in group B (p=0.541). Hepatocellular carcinoma was present in 54.7% of patients in group A vs 38.9% in Group B (p=0.07). The mean of MELD score was 14.4±5 in Group A vs 14.5±6 in Group B (p=NS).The mean ICU stay was 6.8±7 days in Group A versus 6.3±9 days in group B (p=0.638).
The mean transfusion of units of hemoderivates was as follows:
1) Packed red blood cells (PRBC): 12.3±13 units in Group A vs 8.6±10 Group B (p=0.008).
2) Fresh frozen plasma (FFP): 16.2±12 units in group A vs 10.7±8.8 in Group B (p=0.000).
3) Platelets: 2.29±2 units in group A vs 1.7±2 in group B (p=0.014).
Using a logistic regression for multiple predictor variables, the only two factors with statistical significance related with MBT (> 6 units of RBC) were uDCD condition (OR 2.3; CI 95%: 1.2-4.9; p=0.024), and higher Meld score (OR 2.75; CI 95%: 1.7-4.4; p=0.000)
Survival at 1, 3 and 5 years was 81.3%, 70.2% and 68.6%, respectively, in group A vs 89%, 83.7% and 78.8%, respectively, in Group B (p= 0.070)
Discussion.
Conclusion: The use of liver grafts from uDCD donors is associated with increased necessity of transfusion of hemoderivates in comparison with the use of BDD donors.
