Diego Davila and Ruben Ciria have equally contributed to the development of this manuscript.
Prediction Models of Donor Arrest and Graft Utilization in Liver Transplantation From Maastricht-3 Donors After Circulatory Death
Article first published online: 27 SEP 2012
© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 12, Issue 12, pages 3414–3424, December 2012
How to Cite
Davila, D., Ciria, R., Jassem, W., Briceño, J., Littlejohn, W., Vilca-Meléndez, H., Srinivasan, P., Prachalias, A., O’Grady, J., Rela, M. and Heaton, N. (2012), Prediction Models of Donor Arrest and Graft Utilization in Liver Transplantation From Maastricht-3 Donors After Circulatory Death. American Journal of Transplantation, 12: 3414–3424. doi: 10.1111/j.1600-6143.2012.04242.x
- Issue published online: 30 NOV 2012
- Article first published online: 27 SEP 2012
- Received 22 February 2012, revised 12 July 2012 and accepted for publication 13 July 2012
- Maastricht III;
Shortage of organs for transplantation has led to the renewed interest in donation after circulatory–determination of death (DCDD). We conducted a retrospective analysis (2001–2009) and a subsequent prospective validation (2010) of liver Maastricht-Category-3-DCDD and donation-after-brain-death (DBD) offers to our program. Accepted and declined offers were compared. Accepted DCDD offers were divided into donors who went on to cardiac arrest and those who did not. Donors who arrested were divided into those producing grafts that were transplanted or remained unused. Descriptive comparisons and regression analyses were performed to assess predictor models of donor cardiac arrest and graft utilization. Variables from the multivariate analysis were prospectively validated. Of 1579 DCDD offers, 621 were accepted, and of these, 400 experienced cardiac arrest after withdrawal of support. Of these, 173 livers were transplanted. In the DCDD group, donor age < 40 years, use of inotropes and absence of gag/cough reflexes were predictors of cardiac arrest. Donor age >50 years, BMI >30, warm ischemia time >25 minutes, ITU stay >7 days and ALT ≥ 4× normal rates were risk factors for not using the graft. These variables had excellent sensitivity and specificity for the prediction of cardiac arrest (AUROC = 0.835) and graft use (AUROC = 0.748) in the 2010 prospective validation. These models can feasibly predict cardiac arrest in potential DCDDs and graft usability, helping to avoid unnecessary recoveries and healthcare expenditure.