Prediction Models of Donor Arrest and Graft Utilization in Liver Transplantation From Maastricht-3 Donors After Circulatory Death

Authors

  • D. Davila,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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    • Diego Davila and Ruben Ciria have equally contributed to the development of this manuscript.

  • R. Ciria,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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    • Diego Davila and Ruben Ciria have equally contributed to the development of this manuscript.

    • Ruben Ciria is supported by a scholarship from the Spanish Society of Liver Transplantation (Sociedad Española de Trasplante Hepático SETH 2009–2010).

  • W. Jassem,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • J. Briceño,

    1. Unit of Liver Transplantation, University Hospital Reina Sofia, Córdoba, Spain
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  • W. Littlejohn,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • H. Vilca-Meléndez,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • P. Srinivasan,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • A. Prachalias,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • J. O’Grady,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • M. Rela,

    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
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  • N. Heaton

    Corresponding author
    1. Institute of Liver Studies, King's Health Partners at King's College Hospital, London, United Kingdom
      Nigel Heaton, nigel.heaton@nhs.net
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Nigel Heaton, nigel.heaton@nhs.net

Abstract

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.

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