Donation after Circulatory Death (Videos Available)

Thursday July 05, 2018 from 08:30 to 09:30

Room: N-107/108

603.3 Liver transplantation from donor after cardiac death (DCD) Maastricht type IIA: Comparative study of outcomes during the initial five years and on (Video Available)

Award Winner

María García-Conde Delgado, Spain has been granted the TTS-SET International Transplantation Scientific Mentee-Mentor Award

María García-Conde Delgado, Spain

Hospital Universitario 12 de Octubre

Abstract

Liver Transplantation from Donor after Cardiac Death (DCD) Maastricht type IIA, our Experience after 10 years

María García-Conde Delgado1, Iago Justo Alonso1, Oana Anisa Nutu1, Marina Pérez-Flecha González1, Pilar Del Pozo Elso1, Isabel Lechuga Alonso1, Alejandro Manrique Municio1, Óscar Caso Maestro1, Alberto Marcacuzco Quinto1, Laura Alonso Murillo1, Jorge Calvo Pulido1, Félix Cambra Molero1, Álvaro García-Sesma Pérez-Fuentes1, Cristina Cobo Vázquez1, Carmelo Loinaz Segurola1, Carlos Jiménez Romero1.

1Hepatobiliopancreatic Surgery and Abdominal Organ Transplantation Department, Hospital 12 de Octubre, Madrid, Spain

Introduction: Ten years after the beginning of the donation after cardic death (DCD) programme in the University Hospital 12 de Octubre, we study the evolution of the results of said programme over time.
Objectives: To compare the results of liver transplantation (LT) using grafts obtained from donors after cardiac death (DCD type Maastricht IIA) performed during the first period (A) of the programme (January 2006 to December 2010) versus those performed during a later period defined from January 2011 to December 2016 (B).
Materials and Methods: Retrospective analysis of the DCD liver transplantation series in the University Hospital 12 de Octubre
Results: 75 LT from DCD type IIA have been reviewed, 44 performed during period A and 31 during period B. Mean recipient ages were 59+8 y 58+6 (NS) respectively, with a similar number of male patients (79,5% vs. 71% NS). There were no statistically significant differences found regarding other recipient characteristics such as MELD score, hepatocellular carcinoma or HCV infection. Mean donor age was 38+9 years in group A and 46+7 in group B (p 0.000). When reviewing ischemia times (IT), cold IT was shorter in group B  (A  7:00 vs. B  6:05; p 0.046) as was warm IT (A  1:08 vs. B  0:58, p 0.025). However NECMO time was significantly shorter during the first period (3:16 vs. 3:37 min, p 0.027).
Recipient survival during period A at 1, 3 and 5 years was 77.3%, 61.4% and 59.1% while during period B it was 87.1%, 83.7% and 83.7% (p 0.039). Graft survival after period A was significantly lower as well (63.6%, 50% and 47.7% vs. 83.9%, 80.5% and 80.5% in group B; p 0.008). The incidence of ischemic cholangiopathy was higher in group A (43.2% vs. 13.3%; p 0.006), as well as the retransplantation rate (A 18.2% vs. B 3.2%; p 0.05). There were non-statistically significant differences found regarding the incidence of primary graft non-function (A 11.4% vs. 3.3% in group B; p 0.214).
Conclusions:: The study shows a significant improvement in the results of DCD liver transplantation through time, possibly related to graft ischemia time optimization.



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