Outcome after transplantation of liver grafts from diabetic donors: a national multicenter study

I.M.A. Brüggenwirth, M. van Reeven, I. Vasiliauskaite, B. van Hoek, A.E. Braat, A.P. van den Berg, H.J. Metselaar, W.G. Polak, R.J. Porte

Thursday 14 march 2019

13:43 - 13:45h at Tropentheater

Categories: Klinisch/Basaal, Parallelsessie

Parallel session: Parallelsessie XV – Basaal / Klinisch 2

Background: As the incidence of diabetes mellitus (DM) continues to grow, an increased number of potential deceased organ donors with DM can be expected. Outcome after transplantation of livers from deceased, diabetic organ donors, however, is not well documented. We aimed to analyze outcomes after transplantation of livers from diabetic donors and compare donors with type I or type II DM.

Methods: All transplant procedures of liver grafts from diabetic donors, performed in one of the three liver transplant centers in the Netherlands between 2006–2016, were included. A matched control group of transplantations with non-diabetic liver grafts was selected using a 1:2 matching for year of transplantation, retransplantation, and balance at risk score. Outcome parameters were 90-day, 1-year, and 3-year graft and patient survival rates, incidence of primary non-function (PNF), hepatic artery thrombosis (HAT), and non-anastomotic biliary strictures (NAS).

Results: A total of 69 transplantations of liver grafts from diabetic donors were identified and matched with 138 non-diabetic donor liver transplants. Of diabetic donors, 22 had type I and 37 had type II DM (data was missing for 10 cases). Moreover, 11/69 were donation after circulatory death donors (DCD) and 58/69 donation after brain death donors. Graft and patient survival rates were significantly lower in recipients of livers from a diabetic donor, compared to recipients of non-diabetic livers. Graft survival at 90-day, 1 and 3 years was 88.4%, 84.1%, and 78.3%, for livers from diabetic donors versus 96.4%, 91.3%, and 89.1% for non-diabetic donors. Interestingly, NAS occurred less often in recipients of the diabetic liver group (4.3% vs. 14.6%, p=0.032), whereas HAT occurred more frequently in these recipients (8.7% vs. 2.2%, p=0.030). There were no differences in outcome after transplantation of livers from donors with type I or type II DM. Noteworthy, transplantation of livers from diabetic DCD donors resulted in very favorable outcomes with 91% 3-year graft survival, 100% 3-year patient survival, no PNF or HAT, and only 1/11 recipients developed NAS.

Conclusions: Overall outcome after transplantation of livers from deceased donors with DM is inferior compared to transplantation of liver grafts from non-diabetic donors. However, transplantation of livers from selected DCD donors with DM had a favorable outcome and diabetes in a DCD donor should, therefore, not be considered a contraindication for liver donation.