Donation After Cardiac Death in Liver Transplantation: An Additional Source of Organs With Similar Results to Donation After Brain Death.

BACKGROUND: As new sources of organs are needed, liver transplantation using donors after cardiac death (DCD) is progressively increasing, but outcomes with this method are still questioned. This study was accomplished to verify that DCD outcomes are comparable to those seen in donation after brain death (DBD). METHODS: This was a prospective cohort study including 100 liver transplantation performed between 2014 and 2017, divided according to donor type in 75 DBD and 25 DCD. RESULTS: DCD donors were younger (mean age: DCD 56 years, DBD 59 years; P = .009). Mean Modified End-stage Liver Disease (MELD) score was lower for DCD (DCD 16, DBD 19; P < .001). No differences were found regarding ischemia times and development of postreperfusion syndrome or coagulopathy. Primary graft dysfunction was more frequent in DCD (60%, DCD 29.3%; P = .006). Rates of primary graft nonfunction (DCD 0%, DBD 1.3%; P = .562) and acute rejection (DCD 20%, DBD 16.4%; P = .685) were similar. Acute kidney injury occurred more often in DBD (DCD 32%, DBD 12%; P = .051). Length of stay was comparable. Rates of biliary complications (DCD 20%, DBD 26.7%; P = .505) were similar, unlike ischemic cholangiopathy (DCD 12%, DBD 1.3%; P = .018). Retransplantation rates were also similar (DCD 8%, DBD 4%; P = .427) as was survival rate after 3 years (DCD 84%, DBD 86.7%; P = .739). CONCLUSION: DCD represents an additional graft source with results that are encouraging and may be comparable to DBD with a careful donor and recipient selection.

Multicentric Study of the Andalusian Experience in Polycystic Liver Disease as Indication for Liver Transplantation.

BACKGROUND: The purpose of this study was to determine the morbidity and survival in patients with polycystic liver disease (PLD) undergoing liver transplantation (LT) in 4 Spanish hospitals. METHODS: A multicentric retrospective study using a prospective database was designed including 19 LTs after PLD diagnosis performed from January 1, 1990, to December 31, 2016. Pediatric patients were excluded from the analysis. RESULTS: Of the included patients, 63.2% were female, the overall average age was 52.16 ± 11.276 years, median time on the waiting list was 394 days (interquartile range [IQR], 96.25-464.50) and most of them were classified with Model for End-Stage Liver Disease scores of ≤17. Eleven patients received isolated LT, 1 patient had a previous kidney transplantation (KT), and 7 patients received combined liver-kidney transplantation, 4 of them with a previous nephrectomy. Complications include hepatopulmonary syndrome in 10.5%, paralytic ileus in 10.5%, transient renal dysfunction in 10.5%, and hepatorenal syndrome in 5.3%. The most common surgical complication was bleeding (15.8%). Three patients presented graft rejection, which was treated by means of immunosuppressive optimization (15.8%), with corticosteroid addition needed in 1 of them. Thrombosis of the hepatic artery occurred in 3 patients, requiring retransplantation in 2 of them. Most of the patients had improved renal function after the procedure. The mortality rate was 15.8%, related to tumors or sepsis, with an estimated 86% 5-year graft survival. CONCLUSIONS: PLD as indication of LT presents a low complications rate and better graft survival and renal function, especially when KT is associated with LT.