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Title: Predictors of early graft loss in donation after circulatory death liver transplantation.
Austin Authors: Riddiough, Georgina E ;Jones, Robert M ;Vaughan, Rhys B ;Testro, Adam G ;Gow, Paul J ;Wang, B.Z.;Starkey, Graham M ;Fink, Michael A 
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
Department of Surgery, University of Melbourne, Melbourne, Australia
Issue Date: 30-Nov-2013
Abstract: Introduction: Liver transplantation using grafts from donation after circulatory death (DCD) donors has been shown to result in inferior outcomes. The identification of controllable factors that can predict graft loss is crucial and could positively impact graft and patient outcome. Methods: We retrospectively collected data for all DCD liver transplants performed at this centre. We compared DCD liver grafts functioning > 1month with those grafts that were lost (including due to patient death) ? 1month follow-up with regard to donor and recipient variables. Donor variables assessed included age, cause of death, donor risk index, use of antemortem heparin, time from extubation to perfusion, time from systolic blood pressure ? 50mmHg to perfusion, interstate offer and cold ischaemia time. Recipient factors assessed included age, MELD score, TSANZ listing status, medical status and ventilatory support. Results: Between 1 October 2007 and 31 December 2012 16 DCD liver transplants were performed. Graft loss by 1 month follow-up occurred in 31% (n=5). Factors which significantly increased the risk of early graft loss included not giving antemortem heparin (p=0.049), time from systolic blood pressure ? 50mmHg to perfusion greater than 15 mins (p=0.037), cold ischaemia time > 420mins (p=0.049), interstate donor offer (p=0.025), ventilatory support (p=0.025) and recipient listed TSANZ status 1 (p=0.025). Conclusion: Controllable factors such as the administration of antemortem heparin, warm ischaemia time, cold ischaemia time and recipient selection can influence graft outcome in DCD liver transplantation.
Description: Conference Publication: Transplantation 2013; 96 (SUPPL. 10S): S263). Date of Publication: 27 Nov 2013.
Conference Name: Transplantation. Conference: 12th Congress of the International Society for Organ Donation and Procurement, ISODP 2013
Conference Number/Code: 12
Conference Location: Sydney, NSW Australia
Type: Conference
Subjects: graft failure
liver transplantation
organ donor
liver graft
follow up
systolic blood pressure
cause of death
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