Original Article
Survival of Recipients of Livers From Donation After Circulatory Death Who Are Relisted and Undergo Retransplant for Graft Failure

https://doi.org/10.1111/ajt.12700Get rights and content
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Use of grafts from donation after circulatory death (DCD) as a strategy to increase the pool of transplantable livers has been limited due to poorer recipient outcomes compared with donation after brain death (DBD). We examined outcomes of recipients of failed DCD grafts who were selected for relisting with regard to waitlist mortality and patient and graft survival after retransplant. From the Scientific Registry of Transplant Recipients database, we identified 1820 adults who underwent first deceased donor liver transplant January 1, 2004 to June 30, 2011, and were relisted due to graft failure; 12.7% were DCD recipients. Compared with DBD recipients, DCD recipients had better waitlist survival (90-day mortality: 8%, DCD recipients; 14–21%, DBD recipients). Of 950 retransplant patients, 14.5% were prior DCD recipients. Graft survival after second liver transplant was similar for prior DCD (28% graft failure within 1 year) and DBD recipients (30%). Patient survival was slightly better for prior DCD (25% death within 1 year) than DBD recipients (28%). Despite higher overall graft failure and morbidity rates, survival of prior DCD recipients who were selected for relisting and retransplant was not worse than survival of DBD recipients.

Key words:

Graft survival
liver transplantation
outcomes
patient survival
waitlist mortality

Abbreviations

CI
confidence interval
DBD
donation after brain death
DCD
donation after circulatory death
HCV
hepatitis C virus
HR
hazard ratio
MELD
Model for End-Stage Liver Disease
OPTN
Organ Procurement and Transplantation Network
SRTR
Scientific Registry of Transplant Recipients

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