Liver transplantation with donation after cardiac death donors: a comprehensive update

J Surg Res. 2012 Nov;178(1):502-11. doi: 10.1016/j.jss.2012.04.044. Epub 2012 May 10.


Background: Use of donation after cardiac death (DCD) donors has been proposed as an effective way to expand the availability of hepatic allografts used in orthotopic liver transplantation (OLT); yet, there remains no consensus in the medical literature as to how to choose optimal recipients and donors based on available information.

Methods: We queried the United Network of Organ Sharing/Organ Procurement and Transplantation Network database for hepatic DCD allografts used in OLT. As of March 31, 2011, 85,148 patients received hepatic allografts from donation-after-brain-death (DBD) donors, and 2351 patients received hepatic allografts from DCD donors. We performed survival analysis using log-rank and Kaplan-Meier tests. We performed univariate and multivariate analyses using the Cox proportional hazards model. All statistics were performed with SPSS 15.0.

Results: Patients receiving hepatic DCD allografts had significantly worse survival compared with patients receiving hepatic DBD allografts. Pediatric patients who received a hepatic DCD allograft had similar survival to those who received a hepatic DBD allograft. The optimal recipient-related characteristics were age <50 y, International Normalized Ratio <2.0, albumin >3.5 gm/dL, and cold ischemia time <8 h; optimal donor-related characteristics included age <50 y and donor warm ischemia time <20 min.

Conclusions: By identifying certain characteristics, the transplant clinician's decision-making process can be assisted so that similar survival outcomes after OLT can be achieved with the use of hepatic DCD allografts.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Brain Death*
  • Child
  • Databases, Factual / statistics & numerical data*
  • Death*
  • Donor Selection / statistics & numerical data*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Transplantation / mortality*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Tissue Donors / statistics & numerical data
  • Tissue and Organ Procurement / statistics & numerical data
  • Transplantation, Homologous