Outcomes after liver transplantation using deceased after circulatory death donors: A comparison of outcomes in the UK and the US

Abstract

Background and Aims Identifying international differences in utilization and outcomes of liver transplantation (LT) after donation after circulatory death (DCD) donation provides a unique opportunity for benchmarking and population‐level insight. Methods Adult (≥18 years) LT data between 2008 and 2018 from the UK and US were used to assess mortality and graft failure after DCD LT. We used time‐dependent Cox‐regression methods to estimate hazard ratios (HR) for risk‐adjusted short‐term (0–90 days) and longer‐term (90 days–5 years) outcomes. Results One‐thousand five‐hundred‐and‐sixty LT receipts from the UK and 3426 from the US were included. Over the study period, the use of DCD livers increased from 15.7% to 23.9% in the UK compared to 5.1% to 7.6% in the US. In the UK, DCD donors were older (UK:51 vs. US:33 years) with longer cold ischaemia time (UK: 437 vs. US: 333 min). Recipients in the US had higher Model for End‐stage Liver Disease (MELD) scores, higher body mass index, higher proportions of ascites, encephalopathy, diabetes and previous abdominal surgeries. No difference in the risk‐adjusted short‐term mortality or graft failure was observed between the countries. In the longer‐term (90 days–5 years), the UK had lower mortality and graft failure (adj.mortality HR:UK: 0.63 (95% CI: 0.49–0.80); graft failure HR: UK: 0.72, 95% CI: 0.58–0.91). The cumulative incidence of retransplantation was higher in the UK (5 years: UK: 11.9% vs. 4.6%; p < .001). Conclusions For those receiving a DCD LT, longer‐term post‐transplant outcomes in the UK are superior to the US, however, significant differences in recipient illness, graft quality and access to retransplantation were seen between the two countries.

Sequential Normothermic Regional Perfusion and End-ischemic Ex Situ Machine Perfusion Allow the Safe Use of Very Old DCD Donors in Liver Transplantation

“…The combined use of DCD and very old grafts (eg, >70 y old) could further increase the risk of graft dysfunction and post-LT complications, and very few reports on septuagenarian DCD exist. 9,10 We herein report our series of very old cDCD performed with the sequential use of NRP + end-ischemic MP to demonstrate the safety and feasibility of these donors in LT.…”

“…The combined use of DCD and very old grafts (eg, >70 y old) could further increase the risk of graft dysfunction and post-LT complications, and very few reports on septuagenarian DCD exist. 9,10…”