Livers donated after cardiac death safe to use in liver cancer

Volume 4, Issue 3, 2015

Summary

Expanding donation options could help reduce organ shortages for liver transplants.

Photograph of Kristopher (Kris) P. Croome, M.D., of Mayo Clinic

Kristopher (Kris) P. Croome, M.D.

Some patients with liver cancer can be cured with a liver transplant. But because of the shortage of donated organs, these patients often die waiting for a liver. That's partly because most transplant centers typically use livers only from donors who die of brain death.

But in the largest study of its kind, transplant physicians at Mayo Clinic's campus in Florida have found that liver cancer patients have the same beneficial outcomes whether using livers from donors who died after certain cases of cardiac death or after brain death. The study was published in the American Journal of Transplantation in May 2015.

"Our program has one of the largest experiences in the world with liver transplants using donations after cardiac death," said the study's lead investigator, transplant surgeon Kristopher (Kris) P. Croome, M.D. "We now know that these organs effectively offer new life for patients with liver cancer. I believe this study firmly and finally answers the question as to whether liver donations after cardiac death are as viable for patients with liver cancer as are livers from donors who die from brain death. They are."

Using organs after cardiac death for liver transplants could increase the number of transplants performed by 10 percent to 15 percent nationwide, Dr. Croome said, possibly reducing some of the organ shortage.

"One reason why the wait time for liver transplant is short at Mayo Clinic's campus in Florida is that we efficiently and successfully use both types of donated livers," he said. "But nationwide, over the last decade, the transplant list and the number of liver cancer patients have been increasing."

Some studies have suggested that liver donation after cardiac death has inferior results in patients with liver cancer because the donated liver sustains some damage from loss of oxygen during organ recovery. The concern has been that these donor livers may not be healthy enough to fight off development of new cancer if donor recipients have any circulating tumor cells at the time of transplant, Dr. Croome said.

But his research study found that wasn't the case.

Between 2003 and 2012, the team from the Transplant Center at Mayo Clinic's campus in Florida transplanted 1,633 livers using organs from donors with brain death and 241 livers from donors with cardiac death.

In this study, the investigators identified 397 liver cancer patients who received a new liver — 340 patients who received a liver after brain death and 57 patients who received a liver after cardiac death. Researchers found no difference in liver cancer recurrence between the two groups: Liver cancer recurred in about 12 percent of patients in both donor groups.

A person who dies of a heart attack is not considered for liver donation. Instead, cardiac death is controlled in a patient who has decided to be an organ donor.

"This can occur, for example, in a patient who has had a bad brain injury and will not recover," Dr. Croome explained. "In this controlled setting, with the purpose of donating organs, a patient is taken off life support and will pass into death. Then after a short time period, the organs will be recovered and donated."