You are here

Article Text

Article menu

Download PDFPDF

XML
Gastroenterology and hepatology
Research
Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study
  1. Christopher J Callaghan1,
  2. Susan C Charman2,3,
  3. Paolo Muiesan4,
  4. James J Powell5,
  5. Alexander E Gimson1,
  6. Jan H P van der Meulen2,3,
  7. on behalf of the UK Liver Transplant Audit
  1. 1Cambridge Transplant Centre, Addenbrooke's Hospital, Cambridge, UK
  2. 2Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
  3. 3Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Department of Liver Transplantation and Hepatopancreatobiliary Surgery, Queen Elizabeth Hospital, Birmingham, UK
  5. 5Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Jan H P van der Meulen; jan.vandermeulen{at}lshtm.ac.uk

Abstract

Objectives Outcomes of liver transplantations from donation after circulatory death (DCD) donors may be inferior to those achieved with donation after brain death (DBD) donors. The impact of using DCD donors is likely to depend on specific national practices. We compared risk-adjusted graft loss and recipient mortality after transplantation of DCD and DBD livers in the UK.

Design Prospective cohort study. Multivariable Cox regression and propensity score matching were used to estimate risk-adjusted HR.

Setting 7 liver transplant centres in the National Health Service (NHS) hospitals in England and Scotland.

Participants Adults who received a first elective liver transplant between January 2005 and December 2010 who were identified in the UK Liver Transplant Audit.

Interventions Transplantation of DCD and DBD livers.

Outcomes Graft loss and recipient mortality.

Results In total, 2572 liver transplants were identified with 352 (14%) from DCD donors. 3-year graft loss (95% CI) was higher with DCD livers (27.3%, 21.8% to 33.9%) than with DBD livers (18.2%, 16.4% to 20.2%). After adjustment with regression, HR for graft loss was 2.3 (1.7 to 3.0). Similarly, 3-year mortality was higher with DCD livers (19.4%, 14.5% to 25.6%) than with DBD livers (14.1%, 12.5% to 16.0%) with an adjusted HR of 2.0 (1.4 to 2.8). Propensity score matching gave similar results. Centre-specific adjusted HRs for graft loss and recipient mortality seemed to differ among transplant centres, although statistical evidence is weak (p value for interaction 0.08 and 0.24, respectively).

Conclusions Graft loss and recipient mortality were about twice as high with DCD livers as with DBD livers in the UK. Outcomes after DCD liver transplantation may vary between centres. These results should inform policies for the use of DCD livers.

  • Transplantation
  • EPIDEMIOLOGY
  • STATISTICS & RESEARCH METHODS

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-003287

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text