J. R. Schroering1, C. A. Kubal1, B. Ekser1, J. A. Fridell1, R. S. Mangus1 1Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction:
Transplantation of liver grafts from donors who have experienced cardiopulmonary arrest is common practice. The impact of so-called donor “downtime,” the cumulative time of donor asystole, has not been well described. This study reviews a large number of liver transplants at a single center to quantitate the frequency and length of deceased donor arrest. Post-transplant clinical outcomes include delayed graft function, early graft loss, peak post-transplant transaminase levels, recipient length of hospital stay, and short- and long-term graft survival.
Methods:
The records of all liver transplants performed at a single center over a 15-year period were reviewed. Donor arrest included any reported asystole, and the time period of asystole was calculated from the pre-hospital reports as recorded by the onsite organ procurement coordinator. Peak donor transaminase levels were extracted from the original on-site records. Post-transplant graft function was assessed using measured laboratory values including alanine aminotransferase (ALT), total bilirubin (TB), and international normalized ratio (INR). Cox regression was employed to assess graft survival, with a direct entry method for covariates with p<0.10.
Results:
The records for 1830 deceased donor liver transplants were reviewed. There were 521 donors who experienced cardiopulmonary arrest (28%). The median arrest time was 21 minutes (mean 25, range 1 to 120, SD 18). The median peak pre-procurement ALT for donors with arrest time was 127u/L, compared to 39u/L for donors with no arrest (p<0.001). Post-transplant, the peak ALT for liver grafts from donors with arrest was 436u/L, compared to 513u/L for donors with no arrest (p=0.09). Early allograft dysfunction occurred in 27% and 29% of arrest and no arrest donors (p=0.70). Comparing recipients with donor arrest and no arrest, there was no difference in risk of early graft loss (3% vs 3%, p=0.84), recipient length of hospital stay (10 vs 10 days, p=0.76), and 30-day graft survival (94% vs 95%, p=0.60). Cox regression comparing four groups of patients (no arrest, < 20 minutes arrest, 20 to 40 minute arrest and >40 minutes arrest) demonstrated no statistical difference in survival at 10 years.
Conclusion:
These results support the routine use of deceased liver donors who experience cardiopulmonary arrest in the period immediately prior to donation. Prolonged periods of asystole were associated with higher peak elevations in ALT in the donor, but lower peak ALT elevations in the recipient. Peak TB levels were similar in the donors, but significantly lower with increasing arrest time in the recipient. There were no differences in early and late survival.
