Donation after circulatory death; benchmarking; liver transplantation; morbidity; organ perfusion; risk analysis
Abstract :
[en] BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups. METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75(th)-percentile was considered. RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials. LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.
Disciplines :
Gastroenterology & hepatology Surgery
Author, co-author :
Schlegel, Andrea
van Reeven, Marjolein
Croome, Kristopher
Parente, Alessandro
Dolcet, Annalisa
Widmer, Jeannette
MEURISSE, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Chirurgie abdo, sénologique, endocrine et de transplantation
De Carlis, Riccardo
Hessheimer, Amelia
Jochmans, Ina
Mueller, Matteo
van Leeuwen, Otto B.
Nair, Amit
Tomiyama, Koji
Sherif, Ahmed
Elsharif, Mohamed
Kron, Philipp
van der Helm, Danny
Borja-Cacho, Daniel
Bohorquez, Humberto
Germanova, Desislava
Dondossola, Daniele
Olivieri, Tiziana
Camagni, Stefania
Gorgen, Andre
Patrono, Damiano
Cescon, Matteo
Croome, Sarah
Panconesi, Rebecca
Flores Carvalho, Mauricio
Ravaioli, Matteo
Caicedo, Juan Carlos
Loss, George
Lucidi, Valerio
Sapisochin, Gonzalo
Romagnoli, Renato
Jassem, Wayel
Colledan, Michele
De Carlis, Luciano
Rossi, Giorgio
Di Benedetto, Fabrizio
Miller, Charles M.
van Hoek, Bart
Attia, Magdy
Lodge, Peter
Hernandez-Alejandro, Roberto
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
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