Lower Liver Quality from Donation after Cardiac Death Linked to Drop
A new study, funded in part by the National
Institutes of Health (NIH) and Health Resources and Services
Administration, and published in the January 2013 issue of Liver Transplantation,
a journal of the American Association for the Study of Liver Diseases
(AASLD), found that the non-use of donor livers climbed through 2010 due
to a worsening of donor liver quality, primarily from donation
following cardiac death. Diabetes, donor age, and body mass index (BMI)
were also linked to a decrease in use of organs.
“For patients with end-stage liver disease,
transplantation is the only option for extending life, but organ
availability places constraints on the transplant community,” explains
Dr. Eric Orman with the University of North Carolina School of Medicine
in Chapel Hill. “One of the methods to increase the donor pool is to
include donors with less than ideal health status—those with fatty
livers, older donors, and donation after cardiac death.”
In an attempt to increase available livers for
transplant, the transplant community has gradually extended donation
criteria. However, previous research shows that poor outcomes may occur
following transplant of more inferior organs. In fact, studies have
shown an increased recipient morbidity and mortality risk with donation
after cardiac death (when circulation ceases) than with standard
donation following brain death in which donor circulation is sustained.
For the present study researchers used data from the Organ Procurement
and Transplantation Network (OPTN) to indentify 107,259 deceased donors
in U.S. between 1988 and 2010. Donors were 18 years of age and older
who had a least one organ (liver, heart, intestine, kidney, lung or
pancreas) used for transplantation. The mean donor age was 44 years;
41% were female and 68% were white. Split liver donations and donors
with BMI less than 14 kg/m2 or more than 50 kg/m2 were excluded.
Analysis indicates that 41,503 donations occurred
after June 30, 2004 with 82% of livers used for transplant and 18%
unused. The number of unused livers decreased from 1,958 (66% of
donors) in 1988 to 841 (15%) in 2004, and then increased to 1,345 (21%)
in 2010. Liver non-use was independently linked to older donor age,
greater BMI, diabetes prevalence and donation after cardiac death—all of
which are on the rise in the U.S.
Researchers reported a four-fold increase in the
odds of non-use of livers from donation following cardiac death donors
between 2004 and 2010, with the proportion of nonuse climbing from 9% to
28% during the same time period. “Our findings show nonuse of livers
for transplantation is steadily rising, and is primarily due to donation
after cardiac death,” concludes Dr. Orman. “If these trends continue, a
significant decline in liver transplant availability would be
In a related editorial also published in Liver Transplantation,
Dr. Anton Skaro from the Feinberg School of Medicine at Northwestern
University in Chicago, Ill. concurs, “Utilization of livers donated
after cardiac death increases risk of biliary complications, greater
costs and higher graft failure rates, resulting in a reduction of liver
transplants using organs donated after cardiac death in the U.S. since
2006.” Dr. Skaro suggests that liver transplantation using organs
donated after cardiac death should be encouraged for recipients who
would have poor outcomes by remaining on the waitlist.
Full citations: “Declining Liver Utilization
for Transplant in the United States and the Impact of Donation after
Cardiac Death.” Eric S. Orman, A. Sidney Barritt IV, Stephanie B.
Wheeler, Paul H. Hayashi. Liver Transplantation; (DOI: 10.1002/lt.23547) Print Issue Date: January, 2013.
Editorial: “Donation after Cardiac Death Liver
Transplantation: Another Fly in the Ointment.” Neehar D. Parikh and
Anton I. Skaro. Liver Transplantation; (DOI: 10.1002/lt.23563) Print Issue Date: January, 2013.
Author Contact: Media wishing to speak with Dr. Orman may contact Les Lang with the University of North Carolina School of Medicine at firstname.lastname@example.org.
About the Journal
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.
Since the first application of liver transplantation in a clinical
situation was reported more than twenty years ago, there has been a
great deal of growth in this field and more is anticipated. As an
official publication of the AASLD and the ILTS,
Liver Transplantation delivers current, peer-reviewed articles on
surgical techniques, clinical investigations and drug research — the
information necessary to keep abreast of this evolving specialty. For
more information, please visit http://wileyonlinelibrary.com/journal/livertransplantation
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