Is there a learning curve in donation after cardiac death liver transplantation: A canadian single-centre experience

Background: Outcomes in donation after cardiac death (DCD) liver transplantation (LTx) have been suboptimal compared to donation after brain death. The use of DCD allografts has been associated with higher rates of ischemic cholangiopathy (IC) and primary nonfunction (PNF). This study aims to assess the learning curve of the pioneer Canadian DCD-LTx program. Methods: All cases of DCD-LTx at our centre from July 2006 to August 2015 were analysed. Patients were grouped into two four-year periods: an early and late era. Recipients with < 6 months follow up were excluded. Primary outcomes measured were IC and PNF. Definitions were consistent with the literature. Results: A total of 70 DCD-LTx were performed in our centre, and 62 met study criteria. There were 31 patients in both the early and late era cohorts. Overall, IC and PNF were diagnosed in 9/62 (14.5%) and 4/62 (6.5%) patients, respectively. The donor risk index was significantly lower (2.16 vs 2.44; ρ = 0.018) in the late era. The cause of donor death was significantly different between the two eras (Table 1). IC was diagnosed in 8 patients (25.8%) in the early era and 1 patient (3.33%) in the late era (ρ = 0.026). Two patients in each era had PNF. There was a trend of decreased warm ischemia time (WIT) (35:37 vs 26:43 mins; ρ = 0.062) in the later era. Conclusion: In the later era, DCD-LTx performed at our centre had a significantly lower rate of IC, associated with better donor selection, and perhaps a reduced WIT.Tabled 1Table 1. Demographics and intraoperative data.Donor CharacteristicEarly Era (n=31)Late Era (n=31)P=valueDRI2.44 (±0.48)2.16 (±0.41)0.018AGE (yrs)43.4 (±13.2)37.0 (±14.1)0.070BMI (Kg/m2)25.6 (±5.0)24.5 (±4.5)0.177Cause of deathTrauma12110.026Anoxia615Cerebrovascular accident135Procurement timesCut-Canulation-flush (minutes)0:05:35 (±0:02:32)0:04:41 (±0:02:04)0.129MAP < 55 to flush (minutes)0:22:54 (±0:07:23)0:19:46 (±0:06:34)0.083CIT (hrs)5.44 (±1:17)5.34 (±1:11)0.599WIT (minutes)0:35:37 (±0:24:39)0:26:43 (±0:07:14)0.062Recipient CharacteristicAGE (yrs)53.5 (±8.8)55.6 (±7.1)0.316Meld score (Lab)17 (±8.0)17.7 (±8.5)0.702HCV1020.003HCC78Other1421LOS (days)21.6 (±28.8)28.4 (±33.1)0.394Ischemic Cholangiopathy (IC)8/31 (25.8%)1/31 (3.33%)0.026PNf [n(%)]2/31 [6.4%]2/31 (6.66%)[Demographics and Intraoperative data] Open table in a new tab [Demographics and Intraoperative data]