Decision modelling in donation after circulatory death (DCD) liver transplantation

Donation after cardiac death in the hepatocellular carcinoma patient: Same indication?

“…By using Markov modeling, McLean et al showed that predicted quality-adjusted life at 5 years was significantly higher in patients accepting DCD grafts compared with patients remaining on the waiting list for all laboratory MELD scores >15 at all UK Liver Transplant Units. (9) Moreover, acceptance of a DCD graft was associated with a lower risk of death for MELD > 15. It has been suggested that such modeling can assist decision making in the use of DCD allografts based on the recipient's MELD score.…”

“…The characteristics of donor grafts used by HCC recipients vary by type, indication, and locale. From 2001 to 2011 at all UK liver transplant centers, patients with HCC received 5% of DBD organs, whereas they received 9% of DCD donor organs . This suggests DCD grafts are more likely to be used by HCC recipients.…”

“…In the United States, where use has not increased, outcomes are improving because of more stringent selection in the donors. By using Markov modeling, McLean et al showed that predicted quality‐adjusted life at 5 years was significantly higher in patients accepting DCD grafts compared with patients remaining on the waiting list for all laboratory MELD scores >15 at all UK Liver Transplant Units . Moreover, acceptance of a DCD graft was associated with a lower risk of death for MELD > 15.…”

“…From 2001 to 2011 at all UK liver transplant centers, patients with HCC received 5% of DBD organs, whereas they received 9% of DCD donor organs. (9) This suggests DCD grafts are more likely to be used by HCC recipients. This trend is reflected by the growing use of DCD donors in the United Kingdom and observed in the University Hospitals Birmingham National Health Service Foundation Trust retrospective analysis from 2004 to 2014 where HCC was present in 37% of patients receiving a DCD OLT versus 24% of patients receiving a DBD OLT.…”

Liver transplantation with donation after cardiac death donors as a strategy for recipients with model for end‐stage liver disease score >15: Has the die been cast?

“…(7,8) In the current issue, McLean et al describe a Markov model to assist in the decision to accept or decline a DCD allograft stratified by the recipient's Model for End-Stage Liver Disease (MELD) score. (9) The model predicted the 5-year clinical course for patients on the UK transplant waiting list and found that the predicted quality-adjusted life years gained at 5 years were significantly higher in recipients accepting a DCD graft compared with patients remaining on the waiting list for a donation after brain death (DBD) donor across all MELD score categories >15. Furthermore, acceptance of a DCD graft conferred the lowest risk of death (12.3%) and highest likelihood of being transplanted and complication-free (81.3%) at 5 years.…”