The changing epidemiology of deceased liver donors in adult liver transplantation

L.M. Nieuwenhuis, M. van Londen, M.T. de Boer, R.H.J. de Kleine, A.P. van den Berg, H. Blokzijl, R.J. Porte, V.E.D.M. de Meijer

Thursday 15 march 2018

15:20 - 15:25h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 2: Clinical

Background

The discrepancy between organ availability and demand has forced an increasing use of marginal donor liver grafts, such as livers from older donors and grafts from donation after circulatory death (DCD) donors. Donor graft quality is highly predictive for liver transplant outcome.

Aim

Evaluation of the characteristics of deceased liver donors for adult recipients over time.

Methods

A single-center retrospective cohort study of all deceased liver donors for adult recipients (age 18+ years) from March 1979 to November 2017. Data were derived from the prospectively maintained Eurotransplant database. Donor, organ, and center characteristics were collected. Cause of death was manually cross-checked and categorized according to the ICD10 classification. Differences between transplant eras were tested using a one-way ANOVA.

Results

Between 1979-2017, 1087 adult liver transplantations were performed, divided in the era’s 1979-1999 (409), 2000-2009 (376), and 2010-2017 (302). From 1979-1999, 227 (56%) liver grafts originated from Dutch centers (NL), 103 (26%) from German centers (GE), and 39 (10%) from Belgian centers (BE). Mean±SD donor age was 34±13 years, 228 (56%) were male, and mean BMI was 24±16 kg/m². All grafts except one were from donation after brain death (DBD) donors. Main causes of death were cerebrovascular disease (53%), traumatic brain injury (39%), and diseases of the nervous system (3%). Mean recipient age was 42±12 years. In contrast, from 2010-2017, 209 (69%) liver grafts originated from NL, 62 (21%) from GE, and 18 (6%) from BE (P=0.02). Mean donor age was 52±15 years (P<0.001), 175 (58%) were female, and mean BMI was 26±4 kg/m² (P=0.136). 215 (71%) of grafts were from DBD donors, whereas 84 (28%) grafts were from DCD donors (P<0.001). Main causes of death were cerebrovascular disease (66%), traumatic brain injury (12%) and ischemic heart disease (8%), (P=0.001). Mean recipient age was 51±13 years (P<0.001).

Conclusion

Over the past decennia, the epidemiology of deceased liver donors has significantly shifted towards use of older donors, increased use of DCD donors, increased use of donors from NL, and a change in main cause of death towards more cerebrovascular disease and ischemic heart disease. These data provide insight into the changing epidemiology of deceased liver donors, which should be taken into account when performing outcomes-based research in liver transplantation.