Livers From Pediatric Donation After Circulatory Death Donors Represent a Viable and Underutilized Source of Allograft.
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
07
02
2020
revised:
16
04
2020
accepted:
04
05
2020
pubmed:
14
5
2020
medline:
19
3
2021
entrez:
14
5
2020
Statut:
ppublish
Résumé
Despite increased numbers of donation after circulatory death (DCD) donors, pediatric DCD livers are underused. To investigate possible reasons for this discrepancy, we conducted a retrospective cohort study using 2 data sets from the Organ Procurement and Transplantation Network for all deceased liver donors and for all recipients of DCD liver transplants from March 8, 1993, to June 30, 2018. Pediatric (0-12 years) and adolescent (13-17 years) DCD donors were compared with those aged 18-40 years. We found that pediatric DCD allografts are recovered at a significantly lower rate than from 18-to-40-year-old donors (27.3% versus 56.3%; P < 0.001). However, once recovered, these organs are transplanted at a similar rate to those from the 18-to-40-year-old donor cohort (74.7% versus 74.2%). Significantly more pediatric DCD livers (odds ratio [OR], 3.75; confidence interval [CI], 3.14-4.47) were not recovered compared with adult organs, which were most commonly not recovered due to organ quality (10.2% versus 7.1%; P < 0.001). The 10-year relative risks (RRs) for graft failure and patient death were similar between pediatric and adult DCD donors, with adolescent DCD livers demonstrating improved outcomes. DCD livers transplanted into pediatric donors were protective against graft failure (RR, 0.46; 95% confidence interval [CI], 0.21-0.99) and patient death (RR, 0.16; 95% CI, 0.04-0.69). In conclusion, despite lower rates of recovery, pediatric DCD livers represent a viable organ source for certain adults and children.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1138-1153Informations de copyright
Copyright © 2020 by the American Association for the Study of Liver Diseases.
Références
Doyle MB, Collins K, Vachharajani N, Lowell JA, Shenoy S, Nalbantoglu I, et al. Outcomes using grafts from donors after cardiac death. J Am Coll Surg 2015;221:142-152.
Woodside KJ. Donation after cardiac death and liver transplantation. J Surg Res 2013;184:800-801.
Croome KP, Lee DD, Perry DK, Burns JM, Nguyen JH, Keaveny AP, Taner CB. Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity-matched cohort. Liver Transpl 2017;23:342-351.
U.S. Department of Health & Human Services. Organ Procurement and Transplantation Network. http://optn.transplant.hrsa.gov. Accessed November 19, 2019.
A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968;205:337-340.
Eren EA, Latchana N, Beal E, Hayes D Jr, Whitson B, Black SM. Donations after circulatory death in liver transplant. Exp Clin Transplant 2016;14:463-470.
Mateo R, Cho Y, Singh G, Stapfer M, Donovan J, Kahn J, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant 2006;6:791-796.
Merion RM, Pelletier SJ, Goodrich N, Englesbe MJ, Delmonico FL. Donation after cardiac death as a strategy to increase deceased donor liver availability. Ann Surg 2006;244:555-562.
Abt PL, Desai NM, Crawford MD, Forman LM, Markmann JW, Olthoff KM, Markmann JF. Survival following liver transplantation from non-heart-beating donors. Ann Surg 2004;239:87-92.
Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, et al. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg 2005;242:724-731.
Skaro AI, Jay CL, Baker TB, Wang E, Pasricha S, Lyuksemburg V, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery 2009;146:543-552.
Kalisvaart M, de Haan JE, Polak WG, Metselaar HJ, Wijnhoven BP, IJzermans JN, de Jonge J. Comparison of postoperative outcomes between donation after circulatory death and donation after brain death liver transplantation using the Comprehensive Complication Index. Ann Surg 2017;266:772-778.
Meurisse N, Vanden Bussche S, Jochmans I, Francois J, Desschans B, Laleman W, et al. Outcomes of liver transplantations using donations after circulatory death: a single-center experience. Transplant Proc 2012;44:2868-2873.
Grewal HP, Willingham DL, Nguyen J, Hewitt WR, Taner BC, Cornell D, et al. Liver transplantation using controlled donation after cardiac death donors: an analysis of a large single-center experience. Liver Transpl 2009;15:1028-1035.
Tang JX, Na N, Li JJ, Fan L, Weng RH, Jiang N. Outcomes of controlled donation after cardiac death compared with donation after brain death in liver transplantation: a systematic review and meta-analysis. Transplant Proc 2018;50:33-41.
Abt P, Kashyap R, Orloff M, Jain A, Tsoulfas G, Bozorgzadeh A, Olthoff K. Pediatric liver and kidney transplantation with allografts from DCD donors: a review of UNOS data. Transplantation 2006;82:1708-1711.
Hwang CS, Levea SL, Parekh JR, Liang Y, Desai DM, MacConmara M. Should more donation after cardiac death livers be used in pediatric transplantation? Pediatr Transplant 2019;23:e13323.
de Vera ME, Lopez-Solis R, Dvorchik I, Campos S, Morris W, Demetris AJ, et al. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant 2009;9:773-781.
Selck FW, Grossman EB, Ratner LE, Renz JF. Utilization, outcomes, and retransplantation of liver allografts from donation after cardiac death: implications for further expansion of the deceased-donor pool. Ann Surg 2008;248:599-607.
Foley DP, Fernandez LA, Leverson G, Anderson M, Mezrich J, Sollinger HW, D’Alessandro A. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center. Ann Surg 2011;253:817-825.
Lan C, Song JL, Yan LN, Yang JY, Wen TF, Li B, Xu MQ. Pediatric donor to adult recipients in donation after cardiac death liver transplantation: a single-center experience. Transplant Proc 2017;49:1383-1387.
van Rijn R, Hoogland PE, Lehner F, van Heurn EL, Porte RJ. Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors. PLoS One 2017;12:e0175097.
Laboratory Corporation of America. New ATL Reference Intervals for Children and Adults. Internal Data. http://labcorp.com/assets/5286. Accessed June 2, 2020.
Thomas L, ed. Clinical Laboratory Diagnostics. 1st ed. Frankfurt/Main, Germany: TH-Books Verlagsgesellschaft; 1998:192-202.
Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987;317:1098.
Reyes J, Perkins J, Kling C, Montenovo M. Size mismatch in deceased donor liver transplantation and its impact on graft survival. Clin Transplant 2019;33:e13662.
Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 2006;6:783-790.
Khorsandi SE, Giorgakis E, Vilca-Melendez H, O’Grady J, Heneghan M, Aluvihare V, et al. Developing a donation after cardiac death risk index for adult and pediatric liver transplantation. World J Transplant 2017;7:203-212.
Croome KP, Lee DD, Burns JM, Saucedo-Crespo H, Perry DK, Nguyen JH, et al.; for Mayo Clinic Collaborative in Transplant Research and Outcomes. Outcomes of liver transplantation with liver grafts from pediatric donors used in adult recipients. Liver Transpl 2016;22:1099-1106.
Perkins JD, Dick AA, Healey PJ, Montenovo MI, Biggins SW, Sibulesky L, Reyes JD. New evidence supporting increased use of split liver transplantation. Transplantation 2020;104:299-307.
Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67:321-327.
Riddiough GE, Christophi C, Jones RM, Muralidharan V, Perini MV. A systematic review of small for size syndrome after major hepatectomy and liver transplantation. HPB (Oxford) 2019;22:487-496.
Emre S, Soejima Y, Altaca G, Facciuto M, Fishbein TM, Sheiner PA, et al. Safety and risk of using pediatric donor livers in adult liver transplantation. Liver Transpl 2001;7:41-47.
Eipel C, Abshagen K, Vollmar B. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol 2010;16:6046-6057.
Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 2009;9:746-757.
Gu L, Fang H, Li F, Zhang S, Shen C, Han L. Impact of hepatic arterial hemodynamics in predicting early hepatic arterial thrombosis in pediatric recipients younger than three yr after living donor liver transplantation. Pediatr Transplant 2015;19:273-278.
Shay R, Taber D, Pilch N, Meadows H, Tischer S, McGillicuddy J, et al. Early aspirin therapy may reduce hepatic artery thrombosis in liver transplantation. Transplant Proc 2013;45:330-334.
Algarni AA, Mourad MM, Bramhall SR. Anticoagulation and antiplatelets as prophylaxis for hepatic artery thrombosis after liver transplantation. World J Hepatol 2015;7:1238-1243.
Mindikoglu AL, Emre SH, Magder LS. Impact of estimated liver volume and liver weight on gender disparity in liver transplantation. Liver Transpl 2013;19:89-95.
Nephew LD, Goldberg DS, Lewis JD, Abt P, Bryan M, Forde KA. Exception points and body size contribute to gender disparity in liver transplantation. Clin Gastroenterol Hepatol 2017;15:1286-1293.
Gaither JR, Shabanova V, Leventhal JM. US national trends in pediatric deaths from prescription and illicit opioids, 1999-2016. JAMA Netw Open 2018;1:e186558.
Hsu EK, Shaffer ML, Gao L, Sonnenday C, Volk ML, Bucuvalas J, Lai JC. Analysis of liver offers to pediatric candidates on the transplant wait list. Gastroenterology 2017;153:988-995.
Ge J, Hsu EK, Bucuvalas J, Lai JC. Deceased pediatric donor livers: how current policy drives allocation and transplantation. Hepatology 2019;69:1231-1241.
Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, Edwards EB, et al. Liver. Am J Transplant 2016;16(suppl 2):69-98.
Hsu EK, Mazariegos GV. Global lessons in graft type and pediatric liver allocation: a path toward improving outcomes and eliminating wait-list mortality. Liver Transpl 2017;23:86-95.
Mitchell E, Loomes KM, Squires RH, Goldberg D. Variability in acceptance of organ offers by pediatric transplant centers and its impact on wait-list mortality. Liver Transpl 2018;24:803-809.