A meta-analysis and meta-regression of outcomes including biliary complications in donation after cardiac death liver transplantation

Stephen O'Neill, Amanda Roebuck, Emily Khoo, Stephen J Wigmore, Ewen M Harrison

Research output: Contribution to journalArticlepeer-review

Abstract

Donation after cardiac death (DCD) liver transplantation is increasingly common but concerns exist over the development of biliary complications and ischemic cholangiopathy (IC). This study aimed to compare outcomes between DCD and donation after brain death (DBD) liver grafts. Studies reporting on post-transplantation outcomes after Maastricht category III DCD liver transplantation were screened for inclusion. Odds ratios (OR) with 95% confidence intervals were produced using random-effects models for the incidence of biliary complications, IC, graft and recipient survival. Meta-regression was undertaken to identify between-study predictors of effect size for biliary complications and IC. PROSPERO Record: CRD42012002113. Twenty-five studies with 62 184 liver transplant recipients (DCD = 2478 and DBD = 59 706) were included. In comparison with DBD, there was a significant increase in biliary complications [OR = 2.4 (1.9, 3.1); P < 0.00001] and IC [OR = 10.5 (5.7, 19.5); P < 0.00001] following DCD liver transplantation. In comparison with DBD, at 1 year [OR = 0.7 (0.5, 0.8); P = 0.0002] and 3 years [OR = 0.6 (0.5, 0.8); P = 0.001], there was a significant decrease in graft survival following DCD liver transplantation. At 1 year, there was also a nonsignificant decrease [OR = 0.8 (0.6, 1.0); P = 0.08] and by 3 years a significant decrease [OR = 0.7 (0.5, 1.0); P = 0.04] found in recipient survival following DCD liver transplantation. Eleven factors were entered into meta-regression models, but none explained the variability in effect size between studies. DCD liver transplantation is associated with an increase in biliary complications, IC, graft loss and mortality. Significant unexplained differences in effect size exist between centers.

Original languageEnglish
Pages (from-to)1159-74
Number of pages16
JournalTransplant international
Volume27
Issue number11
DOIs
Publication statusPublished - Nov 2014

Keywords

  • Biliary Tract Diseases
  • Brain Death
  • Death
  • Female
  • Graft Survival
  • Humans
  • Ischemia
  • Liver Transplantation
  • Male
  • Postoperative Complications
  • Regression Analysis
  • Risk Factors
  • Tissue Donors

Fingerprint

Dive into the research topics of 'A meta-analysis and meta-regression of outcomes including biliary complications in donation after cardiac death liver transplantation'. Together they form a unique fingerprint.

Cite this