Organ donation
Liver transplantation from maastricht category 2 non–heart-beating donors: a source to increase the donor pool?

https://doi.org/10.1016/j.transproceed.2004.03.027Get rights and content

Abstract

Introduction

The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non–heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBD was compared with that of 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support with simultaneous application of chest and abdominal compression (CPS; n = 6) or cardiopulmonary bypass (CPB; n = 14) was used to maintain the donors.

Results

At a minimum follow-up of 2 years, actuarial patient and graft survival rates with livers from Maastricht category 2 NHBD were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with organs from HBDs. The graft survival rates was 83% for livers from NHBDs preserved with CPS and 42% in those maintained with CPB.

Section snippets

Donor characteristics

Livers from Maastricht category 2 NHBDs were harvested at 2 hospitals: Hospital Juan Canalejo, La Coruña (n = 6), and Hospital Clínico San Carlos, Madrid (n = 14).

Organ preservation

Two methods of preservation were used according to where the NHBDs occurred. In Hospital Juan Canalejo, the donor remained in the emergency room, and, 5 minutes after declaration of death, CPS was initiated to preserve organ viability. CPS included the maneuvers of CPR with simultaneous application of chest (mechanical) and abdominal

Results

From December 1995 through March 2000, 276 liver transplantations were performed at Hospital Juan Canalejo. In 20 (7%) the donor was a Maastricht category 2 NHBD whose organs were preserved after death declaration either with CPS or CPB.

Discussion

In the present study, transplantation of livers from Maastricht category 2 NHBDs was associated with a patient survival similar to that observed with organs from HBDs; but a graft survival rate that was 18% lower. Four of 5 livers that failed showed PNF, whereas the other graft failed because of biliary strictures. The latter complication as well as a more severe degree of initial liver dysfunction were observed more frequently in grafts from NHBDs than those from HBDs. The higher incidence of

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