Transplant Candidate Outcomes After Declining a DCD Liver in the United States.

Autor:	Ishaque T; New York University Langone Transplant Institute, New York, NY., Eagleson MA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Bowring MG; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Motter JD; New York University Langone Transplant Institute, New York, NY., Yu S; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Luo X; Department of Surgery, University Hospitals/Case Western Reserve University, Cleveland, OH., Kernodle AB; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Gentry S; New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY.; Scientific Registry of Transplant Recipients, Minneapolis, MN., Garonzik-Wang JM; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., King EA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Segev DL; New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY.; Scientific Registry of Transplant Recipients, Minneapolis, MN., Massie AB; New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2023 Dec 01; Vol. 107 (12), pp. e339-e347. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.1097/TP.0000000000004777
Abstrakt:	Background: In the context of the organ shortage, donation after circulatory death (DCD) provides an opportunity to expand the donor pool. Although deceased-donor liver transplantation from DCD donors has expanded, DCD livers continue to be discarded at elevated rates; the use of DCD livers from older donors, or donors with comorbidities, is controversial. Methods: Using US registry data from 2009 to 2020, we identified 1564 candidates on whose behalf a DCD liver offer was accepted ("acceptors") and 16 981 candidates on whose behalf the same DCD offers were declined ("decliners"). We characterized outcomes of decliners using a competing risk framework and estimated the survival benefit (adjusted hazard ratio [95% confidence interval]) of accepting DCD livers using Cox regression. Results: Within 10 y of DCD offer decline, 50.9% of candidates died or were removed from the waitlist before transplantation with any type of allograft. DCD acceptors had lower mortality compared with decliners at 10 y postoffer (35.4% versus 48.9%, P < 0.001). After adjustment for candidate covariates, DCD offer acceptance was associated with a 46% reduction in mortality (0.54 [0.49-0.61]). Acceptors of older (age ≥50), obese (body mass index ≥30), hypertensive, nonlocal, diabetic, and increased risk DCD livers had 44% (0.56 [0.42-0.73]), 40% (0.60 [0.49-0.74]), 48% (0.52 [0.41-0.66]), 46% (0.54 [0.45-0.65]), 32% (0.68 [0.43-1.05]), and 45% (0.55 [0.42-0.72]) lower mortality risk compared with DCD decliners, respectively. Conclusions: DCD offer acceptance is associated with considerable long-term survival benefits for liver transplant candidates, even with older DCD donors or donors with comorbidities. Increased recovery and utilization of DCD livers should be encouraged. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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