Donation after cardiac death: A 29-year experience

doi:10.1016/j.surg.2011.07.057

Surgery

Volume 150, Issue 4, October 2011, Pages 692-702

https://doi.org/10.1016/j.surg.2011.07.057 Get rights and content

Objective

To report the long-term outcomes of 1218 organs transplanted from donation after cardiac death (DCD) donors from January 1980 through December 2008.

Methods

One-thousand two-hundred-eighteen organs were transplanted into 1137 recipients from 577 DCD donors. This includes 1038 kidneys (RTX), 87 livers (LTX), 72 pancreas (PTX), and 21 DCD lungs. The outcomes were compared with 3470 RTX, 1157 LTX, 903 PTX, and 409 lung transplants from donors after brain death (DBD).

Results

Both patient and graft survival is comparable between DBD and DCD transplant recipients for kidney, pancreas, and lung after 1, 3, and 10 years. Our findings reveal a significant difference for patient and graft survival of DCD livers at each of these time points. In contrast to the overall kidney transplant experience, the most recent 16-year period (n = 396 DCD and 1,937 DBD) revealed no difference in patient and graft survival, rejection rates, or surgical complications but delayed graft function was higher (44.7% vs 22.0%; P < .001). In DCD LTX, biliary complications (51% vs 33.4%; P < .01) and retransplantation for ischemic cholangiopathy (13.9% vs 0.2%; P < .01) were increased. PTX recipients had no difference in surgical complications, rejection, and hemoglobin A1c levels. Surgical complications were equivalent between DCD and DBD lung recipients.

Conclusion

This series represents the largest single center experience with more than 1000 DCD transplants and given the critical demand for organs, demonstrates successful kidney, pancreas, liver, and lung allografts from DCD donors.

Section snippets

Data collection

The University of Wisconsin Institutional Review Board approved this study. From January 1, 1980, through December 31, 2008, 1218 organs were transplanted into 1137 recipients from 577 DCD donors. This includes 1038 kidneys (RTX), 87 livers (LTX), 72 pancreas (PTX), and 21 DCD lungs. The outcomes were compared with 3470 RTX, 1157 LTX, 903 PTX, and 409 lung transplants from donors after brain death (DBD). While criteria for machine perfusion of DCD and DBD kidneys was the same, 97.1% of DCD and

Results

Between 1980 and 2008, we performed transplants using 1218 allografts from DCD donors. In the same time period we transplanted 4786 organs from DBD donors. This served as our comparison group.

Discussion

Our large cohort of 1137 recipients of transplants recovered from controlled DCD donors provides 10-year follow-up data to further confirm the value of donation after cardiac death in alleviating the organ shortage crisis. The long-term patient and graft survival data in kidney, pancreas, and lung transplants from DCD donors promotes the idea that non-heart beating donors are on par with SCD transplants in keeping patients off transplant waiting lists with functioning grafts. The success of

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Spain has become one of the most active countries in donation after controlled cardiac death, using normothermic abdominal perfusion with ECMO in more than 50% of all donors - a situation contributed to by the creation of mobile teams to support hospitals lacking this technology. The donation process must be respectful of the wishes and values of the patients and their relatives, especially if there is pre mortem manipulation, and the absence of cerebral perfusion should be guaranteed. The liver is the most benefited organ by reducing biliary complications as well as the loss of grafts. In renal transplantation, the technique could contribute to reduce the incidence of delayed graft function. In addition, the procedure is compatible with surgical rapid recovery in hypothermia when there is also lung donation. The future lies in the consolidation of cardiac donation by extending normothermic perfusion to the thoracic cavity.

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: Supported by grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR), National Institutes of Health (NIH) (D.P.F. and J.D.M.).

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Central Surgical AssociationDonation after cardiac death: A 29-year experience

Objective

Methods

Results

Conclusion

Section snippets

Data collection

Results

Discussion

Am J Transplant

Am J Transplant

Am J Transplant

Am J Transplant

J Thorac Cardiovasc Surg

Am J Transplant

Am J Transplant

Am J Transplant

Am J Transplant

Am J Transplant

The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story

Surgery

Central Surgical Association
Donation after cardiac death: A 29-year experience