Title

Outcomes after liver transplantation using deceased after circulatory death donors: A comparison of outcomes in the UK and the US.

Authors

Tommy Ivanics, Henry Ford HealthFollow
Marco P. A. W Claasen
Madhukar S. Patel
Emmanouil Giorgakis
Shirin E. Khorsandi
Parthi Srinivasan
Andreas Prachalias
Krishna Menon
Wayel Jassem
Miriam Cortes
Blayne A. Sayed
Amit K. Mathur
Kate Walker
Rhiannon Taylor
Nigel Heaton
Neil Mehta
Dorry L. Segev
Allan B. Massie
Jan H. P van der Meulen
Gonzalo Sapisochin
David Wallace

Recommended Citation

Ivanics T, Claasen M, Patel MS, Giorgakis E, Khorsandi SE, Srinivasan P, Prachalias A, Menon K, Jassem W, Cortes M, Sayed BA, Mathur AK, Walker K, Taylor R, Heaton N, Mehta N, Segev DL, Massie AB, van der Meulen JHP, Sapisochin G, and Wallace D. Outcomes after liver transplantation using deceased after circulatory death donors: A comparison of outcomes in the UK and the US. Liver Int 2023.

Document Type

Article

Publication Date

2-3-2023

Publication Title

Liver international

Abstract

BACKGROUND AND AIMS: Identifying international differences in utilization and outcomes of liver transplantation (LT) after donation after circulatory death (DCD) donation provides a unique opportunity for benchmarking and population-level insight.

METHODS: Adult (≥18 years) LT data between 2008 and 2018 from the UK and US were used to assess mortality and graft failure after DCD LT. We used time-dependent Cox-regression methods to estimate hazard ratios (HR) for risk-adjusted short-term (0-90 days) and longer-term (90 days-5 years) outcomes.

RESULTS: One-thousand five-hundred-and-sixty LT receipts from the UK and 3426 from the US were included. Over the study period, the use of DCD livers increased from 15.7% to 23.9% in the UK compared to 5.1% to 7.6% in the US. In the UK, DCD donors were older (UK:51 vs. US:33 years) with longer cold ischaemia time (UK: 437 vs. US: 333 min). Recipients in the US had higher Model for End-stage Liver Disease (MELD) scores, higher body mass index, higher proportions of ascites, encephalopathy, diabetes and previous abdominal surgeries. No difference in the risk-adjusted short-term mortality or graft failure was observed between the countries. In the longer-term (90 days-5 years), the UK had lower mortality and graft failure (adj.mortality HR:UK: 0.63 (95% CI: 0.49-0.80); graft failure HR: UK: 0.72, 95% CI: 0.58-0.91). The cumulative incidence of retransplantation was higher in the UK (5 years: UK: 11.9% vs. 4.6%; p < .001).

CONCLUSIONS: For those receiving a DCD LT, longer-term post-transplant outcomes in the UK are superior to the US, however, significant differences in recipient illness, graft quality and access to retransplantation were seen between the two countries.

PubMed ID

36737866

ePublication

ePub ahead of print