Donation after Cardiac Death Liver Transplantation: Predictors of Outcome

We aimed to identify recipient, donor and transplant risk factors associated with graft failure and patient mortality following donation after cardiac death (DCD) liver transplantation. These estimates were derived from Scientific Registry of Transplant Recipients data from all US liver-only DCD recipients between September 1, 2001 and April 30, 2009 (n = 1567) and Cox regression techniques. Three years post-DCD liver transplant, 64.9% of recipients were alive with functioning grafts, 13.6% required retransplant and 21.6% died. Significant recipient factors predictive of graft failure included: age >= 55 years, male sex, African-American race, HCV positivity, metabolic liver disorder, transplant MELD >= 35, hospitalization at transplant and the need for life support at transplant (all, p < 0.05). Donor characteristics included age >= 50 years and weight > 100 kg (all, p < 0.005). Each hour increase in cold ischemia time (CIT) was associated with 6% higher graft failure rate (HR 1.06, p < 0.001). Donor warm ischemia time >= 35 min significantly increased graft failure rates (HR 1.84, p = 0.002). Recipient predictors of mortality were age >= 55 years, hospitalization at transplant and retransplantation (all, p < 0.006). Donor weight > 100 kg and CIT also increased patient mortality (all, p < 0.035). These findings are useful for transplant surgeons creating DCD liver acceptance protocols.