Liège experience in donation after cardiac death liver transplantation: 2003-2011

Objectives: Results of DCD-LT at the University Hospital of Liège were evaluated from 2003 to 2011.

Methods: Medical records of 56 DCD liver recipients were retrospectively reviewed with regard to patient and graft survivals and biliary complications. Mean follow-up was 26.4 months. Mean donor age was 56.3±14.5 years (25 - 83). Donor causes of death were due to anoxia (51.8%), stroke (32.1%) and head trauma (14.3%). Mean WIT, CIT and suture time were 20.5±7.1min (10 – 39), 265.6±85.1min (105 – 576), and 40.8±7.8 min (25 – 61), respectively. 95% of liver grafts were locally shared. HTK was the most commonly used perfusion solution (86%). Mean recipient age was 56.6±10.5 years (29 – 73). Indications for LT included ESLD (53.6%) and HCC (46.6%). Mean MELD score at transplant was 15.6±6.1points (6 – 40).

Results: No primary non-function grafts. Mean peak serum AST and bilirubin levels were 2520±3621UI/L and 50.2±49.2mg/L, respectively. Eight patients (14.3%) developed biliary complications. No intra-hepatic bile duct strictures or re-transplantation. Global patient and graft survival was 92.6% at 3 months, 92.6% at 1 year, 73.8% at 3 years and 60% at 5 years. Death-censored patient and graft survival at the corresponding time points was 92.6%, 92.6%, 87.7% and 87.7%. Thirteen liver grafts were lost during follow-up exclusively due to recipient deaths. The rate of HCC recurrence was 33.3%.

Conclusions: Controlled DCD donors are a valuable source of transplantable liver grafts. Primary results are encouraging and apparently as good as those from brain-dead donation LT essentially due to short WIT and CIT.