The impact of donor chemical overdose

nighthawk

Transplantation 2003; 76(4):705-708

The impact of donor chemical overdose on the outcome of liver
transplantation

Teruo Komokata 1; Seigo Nishida 2; Susan Ganz 2; Tomomi Suzuki 2; Les Olson
2; Andreas G. Tzakis 2 3
Background.
To overcome the critical shortage of liver grafts, many centers have been
widening the acceptance criteria for liver donation. Use of liver grafts
from victims who have suffered chemical overdose (COD) may be one option
that could help to expand the donor pool. However, this practice has been
poorly documented.

Methods.
Of 1,195 orthotopic liver transplantations performed at our institution
between June 1994 and March 2001, 22 involved livers (1.8%) were retrieved
from COD donors. Donor and recipient characteristics and posttransplantation
outcomes were analyzed retrospectively.

Results.
The main chemicals causing brain death of the donor were carbon monoxide
(n=4), cocaine (n=4), tricyclic antidepressants (n=3), 3,4-methylenedioxy-
methamphetamine (n=2), opiates (n=2), aspirin (n=1), gamma hydroxybutyrate
(n=1), heroin (n=1), insulin (n=1), verapamil (n=1), barbiturate (n=1), and
brompheniramine/phenylpropanolamine (n=1). Primary nonfunction developed in
one patient who had received a liver from an
3,4-methylenedioxymethamphetamine-intoxicated donor. Another patient died of
fungal meningitis 10 days after transplantation with a functioning graft.
The remaining 20 patients experienced acceptable early graft function, as
demonstrated by initial mean peak values of bilirubin (4.8 mg/dL), aspartate
aminotransferase (624 U/L), and alanine aminotransferase (730 U/L). One-year
graft survival rate estimated by the Kaplan-Meier method was 86%.

Conclusions.
Satisfactory outcomes of graft function were achieved in orthotopic liver
transplantations from COD donors. The cautious use of liver grafts from
selected COD donors may be a worthwhile method of increasing the
availability of scarce donor organs.

1 Second Department of Surgery, Kagoshima University School of Medicine,
Kagoshima, Japan.
2 Department of Surgery, Division of Transplantation, Jackson Memorial
Hospital/University of Miami School of Medicine, Miami, FL.
3 Address correspondence to: Andreas G. Tzakis, M.D., Director, Liver/GI
Transplant Program, Highland Professional Building, Suite 511, 1801 NW 9th
Avenue, Miami, FL 33136. E-mail: [email protected]. edu.

Received 10 October 2002.
Revision Requested 24 December 2002.
Accepted 14 May 2003.