0041-1337/03/7604-705/0 TRANSPLANTATION Vol. 76, 705–708, No. 4, August 27, 2003 Copyright © 2003 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A. 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 AND ANDREAS G. TZAKIS 2,3 Background. To overcome the critical shortage of liver grafts, many centers have been widening the ac- ceptance 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 brom- pheniramine/phenylpropanolamine (n1). Primary nonfunction developed in one patient who had re- ceived a liver from an 3,4-methylenedioxymetham- phetamine-intoxicated donor. Another patient died of fungal meningitis 10 days after transplantation with a functioning graft. The remaining 20 patients experi- enced acceptable early graft function, as demon- strated by initial mean peak values of bilirubin (4.8 mg/dL), aspartate aminotransferase (624 U/L), and ala- nine aminotransferase (730 U/L). One-year graft sur- vival 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. In an effort to overcome the critical shortage of organs for orthotopic liver transplantation (OLT) (1), many centers have been widening the acceptance criteria for liver donation to include the elderly (2); nonheart-beating donors (3); those with hypertensive, renal, or cardiovascular disease (4); and those with positive serologic markers for hepatitis B or C virus (5,6). The use of organs from victims who suffered chemical overdose (COD) with drugs or toxic agents may be an addi- tional possible source of liver grafts (7,8). However, retrieval of liver grafts from COD donors is usually limited because of the potential deleterious effect of chemicals on the donor liver, concomitant hypoxic event, its possible expression in the transplant recipient, and the potential risk of transmis- sion of infectious agents such as hepatitis B or C or human immunodeficiency virus (HIV). Therefore, the possibility of liver donation after COD has been a poorly documented sub- ject (7–9). The aim of this study was to investigate the feasi- bility of OLT from COD donors through a single-center experience. PATIENTS AND METHODS Between June 1994 and March 2001, 1,195 cadaveric OLTs were performed at Jackson Memorial Hospital/University of Miami. Ex- clusion criteria for this study were transplants of multiorgans, split or reduced-size grafts, and grafts from ABO nonidentical donors or those with a cavoportal hemitransposition. Among the remaining cases, 22 liver grafts (1.8%) were retrieved from donors who died of COD with various drugs or toxic agents. The diagnoses of COD were obtained by reviewing the donors’ medical histories, results of urine toxicology screening tests and blood analyses, and relevant findings during the hospital course. Donors who had positive histories of chemical use but whose death was a result of other causes were not included. Donor liver biopsy was performed in case of suspected hepatotoxicity, questionable macroscopic appearance of the graft, or substantial in- crease of the serum aminotransferase levels. OLT was performed by using the piggyback technique (n=18) or the conventional technique (n=4), with or without venovenous bypass. Baseline immunosuppres- sive therapy consisted of tacrolimus and methylprednisolone. The chemicals that contributed to the brain death of the donor, donor and recipient characteristics, and posttransplantation out- comes were retrospectively analyzed. When multiple chemicals were involved in the overdose, the chemical that was most likely to cause brain death was first described. Survival study data are inclusive through February 2003. RESULTS The clinical profiles of the 22 COD donors are summarized in Table 1. The mean age of the donors was 30 years. For 10 donors, multiple chemicals were involved in the overdose. Fourteen donors suffered overdose with illicit drugs such as cocaine, amphetamine, 3,4-methylenedioxymethamphet- amine (MDMA; “ecstasy”), gamma hydroxybutyrate, lysergic acid diethylamide, or opiates such as oxycodone or heroin. The main cause of death was anoxia (45%), and 12 donors experienced an episode of cardiopulmonary arrest with re- suscitation upon admission to the hospital. The last mean value of donor bilirubin was 0.7 (range, 0.2–1.7) mg/dL, that of aspartate aminotransferase (AST) was 149 U/L, and that of alanine aminotransferase (ALT) was 163 U/L (Table 1). A 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, Liv- er/GI Transplant Program, Highland Professional Building, Suite 511, 1801 NW 9th Avenue, Miami, FL 33136. E-mail: atzakis@med.miami. edu. Received 10 October 2002. Revision Requested 24 December 2002. Accepted 14 May 2003. 705 DOI: 10.1097/01.TP.0000079916.07254.3D