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A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation
- Source :
- Journal of Hepatology, 76(2), 371-382, Journal of Hepatology, 76(2), 371-382. ELSEVIER SCIENCE BV, Journal of Hepatology, 76(2), 371-382. Elsevier, Hepatobiliary Surg Nutr
- Publication Year :
- 2021
-
Abstract
- 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 75th-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.
- Subjects :
- Male
Organ Dysfunction Scores
benchmarking
Donation after circulatory death
liver transplantation
morbidity
organ perfusion
risk analysis
IMPACT
medicine.medical_treatment
Kaplan-Meier Estimate
Liver transplantation
GUIDELINES
ALLOCATION
law.invention
Cohort Studies
Postoperative Complications
PROPOSAL
Interquartile range
law
Outcome Assessment, Health Care
risk analysi
Mortality rate
EXTENDED-CRITERIA DONORS
Shock
Middle Aged
Editorial from the ACHBPT
Intensive care unit
CARDIAC DEATH
Area Under Curve
Cohort
Female
medicine.medical_specialty
Tissue and Organ Procurement
BILIARY COMPLICATIONS
Cold storage
CLASSIFICATION
Internal medicine
SCORE
medicine
Humans
Renal replacement therapy
Aged
Proportional Hazards Models
GRAFT-SURVIVAL
Hepatology
business.industry
ROC Curve
Complication
business
Subjects
Details
- Language :
- English
- ISSN :
- 01688278
- Database :
- OpenAIRE
- Journal :
- Journal of Hepatology, 76(2), 371-382, Journal of Hepatology, 76(2), 371-382. ELSEVIER SCIENCE BV, Journal of Hepatology, 76(2), 371-382. Elsevier, Hepatobiliary Surg Nutr
- Accession number :
- edsair.doi.dedup.....dc168590d23230bb14b347975ef586c6