Evidence map›Paper›PMID 34738095›Full record

Observational studyThe British journal of surgery2021

National time trends in mortality and graft survival following liver transplantation from circulatory death or brainstem death donors.

David Wallace, Thomas E Cowling, Abid Suddle, Alex Gimson, Ian Rowe, Chris Callaghan, Gonzalo Sapisochin, Tommy Ivanics, Marco Claasen, Neil Mehta and 3 more

Open access · bronzeAbstract readComparative StudyObservational Study
In one paragraph

Observational study in The British journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
2.5field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 15 citations in OpenAlex.

  1. Improving surgical treatments for hepatocellular carcinoma.Nature reviews. Gastroenterology & hepatology · 2026
    Review
  2. Transplantation of older DCD livers in the machine perfusion era: a U.S. cohort study.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Article
  3. Implementation of a controlled DCD program in Western Austria - key considerations and insights.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Article
  4. Review
  5. Article
  6. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 7 institutions in 3 countries.

David WallaceDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.ORCID 0000-0002-8959-7741
Thomas E CowlingDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Abid SuddleInstitute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
Alex GimsonThe Liver Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Ian RoweLiver Unit, St James' Hospital and University of Leeds, Leeds, UK/Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
Chris CallaghanDepartment of Nephrology and Transplantation, Renal Unit, Guy's Hospital, London, UK.
Gonzalo SapisochinMulti-Organ Transplant, Toronto General Surgery, Toronto, Canada.
Tommy IvanicsMulti-Organ Transplant, Toronto General Surgery, Toronto, Canada.ORCID 0000-0002-1312-4470
Marco ClaasenMulti-Organ Transplant, Toronto General Surgery, Toronto, Canada.
Neil MehtaDivision of Gastroenterology, Department of Medicine, University of California, San Francisco, California, USA.
Nigel HeatonInstitute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
Jan van der MeulenDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Kate WalkerDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
London School of Hygiene & Tropical Medicine · GBUniversity of Toronto · CAKing's College Hospital NHS Foundation Trust · GBCambridge University Hospitals NHS Foundation Trust · GBGuy's Hospital · GBUniversity of California, San Francisco · USUniversity of Leeds · GB

Funding

Medical Research Council MR/S020470/1
6 · The paper itself

Abstract

backgroundDespite high waiting list mortality rates, concern still exists on the appropriateness of using livers donated after circulatory death (DCD). We compared mortality and graft loss in recipients of livers donated after circulatory or brainstem death (DBD) across two successive time periods.

methodsObservational multinational data from the United Kingdom and Ireland were partitioned into two time periods (2008-2011 and 2012-2016). Cox regression methods were used to estimate hazard ratios (HRs) comparing the impact of periods on post-transplant mortality and graft failure.

resultsA total of 1176 DCD recipients and 3749 DBD recipients were included. Three-year patient mortality rates decreased markedly from 19.6 per cent in time period 1 to 10.4 per cent in time period 2 (adjusted HR 0.43, 95 per cent c.i. 0.30 to 0.62; P < 0.001) for DCD recipients but only decreased from 12.8 to 11.3 per cent (adjusted HR 0.96, 95 per cent c.i. 0.78 to 1.19; P = 0.732) in DBD recipients (P for interaction = 0.001). No time period-specific improvements in 3-year graft failure were observed for DCD (adjusted HR 0.80, 95% c.i. 0.61 to 1.05; P = 0.116) or DBD recipients (adjusted HR 0.95, 95% c.i. 0.79 to 1.14; P = 0.607). A slight increase in retransplantation rates occurred between time period 1 and 2 in those who received a DCD liver (from 7.3 to 11.8 per cent; P = 0.042), but there was no change in those receiving a DBD liver (from 4.9 to 4.5 per cent; P = 0.365). In time period 2, no difference in mortality rates between those receiving a DCD liver and those receiving a DBD liver was observed (adjusted HR 0.78, 95% c.i. 0.56 to 1.09; P = 0.142).

conclusionMortality rates more than halved in recipients of a DCD liver over a decade and eventually compared similarly to mortality rates in recipients of a DBD liver. Regions with high waiting list mortality may mitigate this by use of DCD livers.

Indexed as

Brain DeathCause of DeathGraft SurvivalTissue DonorsFemaleHumansIrelandLiver TransplantationMaleMiddle AgedRegistriesReoperationRisk FactorsTime FactorsUnited Kingdom

Identifiers

PMID34738095
PMCPMC10364702
OpenAlexW3210847919

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.