A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation Article

Full Text via DOI: 10.1016/j.jhep.2021.10.004 Web of Science: 000752560300015
International Collaboration

Cited authors

  • Schlegel A, van Reeven M, Croome K, Parente A, Dolcet A, Widmer J, Meurisse N, De Carlis R, Hessheimer A, Jochmans I, Mueller M, van Leeuwen OB, Nair A, Tomiyama K, Sherif A, Elsharif M, Kron P, van der Helm D, Borja-Cacho D, Bohorquez H, Germanova D, Dondossola D, Olivieri T, Camagni S, Gorgen A, Patrono D, Cescon M, Croome S, Panconesi R, Carvalho MF, Ravaioli M, Caicedo JC, Loss G, Lucidi V, Sapisochin G, Romagnoli R, Jassem W, Colledan M, De Carlis L, Rossi G, Benedetto FD, Miller CM, van Hoek B, Attia M, Lodge P, Hernandez-Alejandro R, Detry O, Quintini C, Oniscu GC, Fondevila C, Malago M, Pirenne J, IJzermans JNM, Porte RJ, Dutkowski P, Taner CB, Heaton N, Clavien PA, Polak WG, Muiesan P

Abstract

  • Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values.Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of <= 20 points, receiving a DCD liver with a total donor warm ischemia time of <= 30 minutes and asystolic donor warm ischemia time of <= 15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding bench-mark cut-offs were based on median values of each centre, where the 75th-percentile was considered.Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retrans-plant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (>= Clavien-Dindo-Grade III). Benchmark cut-offs were <= 3 days and <= 16 days for ICU and hospital stay, <= 66% for severe recipient complications (>= Grade III), <= 16.8% for ischemic cholangiopathy, and <= 38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups and to provide a valid comparator cohort for future clinical trials.Lay summary: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2,219 liver transplantations following controlled DCD donation in 17 centres worldwide. Donor and recipient combinations with higher risk had significantly worse outcomes. However, the use of novel organ perfusion technology helped high-risk patients achieve similar outcomes as the benchmark cohort. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Authors

Publication date

  • 2022

Published in

Category

International Standard Serial Number (ISSN)

  • 0168-8278

Number of pages

  • 13

Start page

  • 371

End page

  • 382

Volume

  • 76

Issue

  • 2