Liver transplant outcomes using ideal donation after circulatory death livers are superior to using older donation after brain death donor livers

Abstract

Multiple reports have demonstrated that liver transplantation following donation after circulatory death (DCD) is associated with poorer outcomes when compared with liver transplantation from donation after brain death (DBD) donors. We hypothesized that carefully selected, underutilized DCD livers recovered from younger donors have excellent outcomes. We performed a retrospective study of the United Network for Organ Sharing database to determine graft survivals for patients who received liver transplants from DBD donors of age 60 years, DBD donors < 60 years, and DCD donors < 50 years of age. Between January 2002 and December 2014, 52,271 liver transplants were performed in the United States. Of these, 41,181 (78.8%) underwent transplantation with livers from DBD donors of age < 60 years, 8905 (17.0%) from DBD donors 60 years old, and 2195 (4.2%) livers from DCD donors < 50 years of age. DCD livers of age < 50 years with < 6 hours of cold ischemia time (CIT) had superior graft survival when compared with DBD livers age 60 years (P < 0.001). In 2014, there were 133 discarded DCD livers; of these, 111 (83.4%) were from donors < age 50 years old. Young DCD donor livers (age < 50 years old) with short CITs yield results better than that seen with DBD livers > 60 years old. Careful donor organ and recipient selection can lead to excellent results, despite previous reports suggesting otherwise. Increased acceptance of these DCD livers would lead to shorter wait list times and increased national liver transplant rates.Liver Transplantation 22 1197-1204 2016 AASLD. There exists a vast disparity between the number of patients on the liver transplant waiting list and the number of available organs.(1-4) One method for increasing the number of transplantable organs has been to use organs from patients who die after circulatory death.(5-9) Accordingly, large increases in the number of transplantable kidneys have resulted from donation after circulatory death (DCD) protocols. However, only modest increases in DCD liver transplantation have been observed. (5,10,11) In fact, only approximately 6% of liver transplants in the United States are performed using DCD livers.(12) This lack of growth in the DCD liver pool is due, in part, to the technical challenges of the operation and concern for postoperative complications such as ischemic cholangiopathy. (5,6) As described by Feng et al., (13) not all donor livers yield equivalent recipient outcomes. Much like livers that are recovered from donation after brain death (DBD) donors, DCD livers carry a spectrum of risk. That is, there are some livers which likely function better than others. It is known that the age of the DCD donor is a risk factor for graft loss when compared with DBD organs, particularly when the DCD donor is >50 years of age. (13,14) In addition, cold ischemia time (CIT) has been shown to have a greater effect on Abbreviations: BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after circulatory death; ICU, intensive ca...

Factors associated with long-term survival after liver transplantation: A retrospective cohort study

“…Based on the published literature, strict recommendations for the acceptance or refusal of potential liver donors cannot be made. The authors concluded that careful donor organ and recipient selection can lead to excellent results[14]. …”

Simultaneous Liver and Kidney Transplantation Using Organs from Donation After Circulatory Death Donors in the Contemporary Era: We Are Getting Better!

“…(3) We know that ideal DCD livers, ie, those from donors aged <50 years and with cold ischemia time <6 hours, provide superior graft survival compared with DBD livers from donors older than 60 years. (4) We also know, that in the United Kingdom, accepting a DCD liver for a given recipient provides a significant survival benefit compared with waiting on the list for a DBD liver. (5) These data strongly support the utilization of DCD livers for LT.…”

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“…26 Accordingly, investigators from the University of Wisconsin recently published that, compared with older DBD donors (> 60 y old), graft survival after DCD liver transplant was superior when the DCD donor was young (< 50 y old) and when the DCD liver cold ischemia times were minimized. 26 However, DCD liver transplant outcomes overall were observed to be worse than for DBD liver recipients. These findings suggest that DCD livers should not be turned down in favor of older DBD livers.…”

“…In addition, acceptance of these livers (many are currently discarded) could add many trans plantable organs to the donor pool. 26 …”