Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score–Matched Study From a Single Center

Abstract

The use of livers from donation after circulatory death (DCD) is increasing, but concerns exist regarding outcomes following use of grafts from "marginal" donors. To compare outcomes in transplants using DCD and donation after brain death (DBD), propensity score matching was performed for 973 patients with chronic liver disease and/or malignancy who underwent primary whole-liver transplant between 2004 and 2014 at University Hospitals Birmingham NHS Foundation Trust. Primary end points were overall graft and patient survival. Secondary end points included postoperative, biliary and vascular complications. Over 10 years, 234 transplants were carried out using DCD grafts. Of the 187 matched DCDs, 82.9% were classified as marginal per British Transplantation Society guidelines. Kaplan-Meier analysis of graft and patient survival found no significant differences for either outcome between the paired DCD and DBD patients (p = 0.162 and p = 0.519, respectively). Aspartate aminotransferase was significantly higher in DCD recipients until 48 h after transplant (p < 0.001). The incidences of acute kidney injury and ischemic cholangiopathy were greater in DCD recipients (32.6% vs. 15% [p < 0.001] and 9.1% vs. 1.1% [p < 0.001], respectively). With appropriate recipient selection, the use of DCDs, including those deemed marginal, can be safe and can produce outcomes comparable to those seen using DBD grafts in similar recipients.

Reply to “Reducing Nonanastomotic Biliary Strictures in Donation After Circulatory Death Liver Transplantation

“…Available recommendations differ between 6 and 9 hours, low incidence of IC (9.1%), despite a mean cold ischemia of 7.3 hours, providing that functional donor warm ischemia was kept short (mean 20 minutes). 9 These results correlate with another DCD series reporting only 2.5% IC in 167 DCD livers, exposed to a mean of 7 hours cold storage, together with functional warm ischemia of less than 20 minutes (mean 16 minutes). 10 In contrast, an increase in the asystolic to cross-clamp duration above 9 minutes is associated with a severe increase in the odds for the development of IC or hepatic necrosis by 16% per minute.…”

Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications

“…This would be expected as the use of DCD grafts is associated with increased warm ischaemia, incidence of poor and non function of the graft and patient and graft mortality[27]. In our study we were not able to reproduce these results.…”

Clinical Implications of Donor Warm and Cold Ischemia Time in Donor After Circulatory Death Liver Transplantation

“…Recipient selection is also an important step in liver transplantation, especially in the allocation of marginal organs . The recipients of DCD liver allografts presented a relatively low laboratory MELD score with a median equal to 18 (IQR, 12‐24), whereas in the same period, the median MELD score for brain‐dead donor allograft recipients was 21 (IQR, 14‐31).…”