OPTN/SRTR 2021 Annual Data Report: Liver

Kwong, Allison J.; Ebel, Noelle H.; Kim, W. Ray; Lake, John R.; Smith, Jodi M.; Schladt, David; Schnellinger, Erin M.; Handarova, Dzhuliyana K.; Weiss, Samantha; Cafarella, Matthew; Snyder, Jon J.; Israni, Ajay K.; Kasiske, Bertram L.

doi:10.1016/j.ajt.2023.02.006

Cited by 118 publications

(71 citation statements)

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“…Notably, nearly all kidney transplant candidates are listed for both DCD and DBD offers, and although utilization of DCD organs is highest for kidneys, competition for these organs likely diminishes any benefit to waitlist outcome. Donor organ demand is most pronounced for kidney transplant candidates who were transplanted at a rate of 17.7% in 2021 compared with 32.9% of liver, 61.7% of lung, and 44.6% of heart transplant candidates 4,5,21,22 . In addition, we show that rates of kidney transplantation using DCD were largely uniform across all UNOS regions, whereas other organs demonstrated more regionalized patterns.…”

Section: Discussionmentioning

confidence: 69%

“…Donor organ demand is most pronounced for kidney transplant candidates who were transplanted at a rate of 17.7% in 2021 compared with 32.9% of liver, 61.7% of lung, and 44.6% of heart transplant candidates. 4,5,21,22 In addition, we show that rates of kidney transplantation using DCD were largely uniform across all UNOS regions, whereas other organs demonstrated more regionalized patterns. Correspondingly, DCD kidneys were most likely to be shared locally, whereas other organs were shared in greater proportion at a regional and national level.…”

Section: Discussionmentioning

confidence: 70%

“…Revived interest in organ donation after circulatory death (DCD) led to a formal endorsement of the practice in the United States by the Institute of Medicine in 1997 1,2 . DCD kidney and liver transplantation have since grown in the US, accounting for 30% and 10% of deceased donor transplants in 2021, respectively 3–5 . In contrast, thoracic transplantation using DCD was adopted more slowly, with most US centers reporting their experience with DCD lung transplantation starting in 2004 and with DCD heart transplantation in 2019 6–9 …”

mentioning

confidence: 99%

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Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

et al. 2023

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Objectives: To summarize waitlist and transplant outcomes in kidney, liver, lung, and heart transplantation using organ donation after circulatory death (DCD). Background: DCD has expanded the donor pool for solid organ transplantation, most recently for heart transplantation. Methods: The United Network for Organ Sharing registry was used to identify adult transplant candidates and recipients in the most recent allocation policy eras for kidney, liver, lung, and heart transplantation. Transplant candidates and recipients were grouped by acceptance criteria for DCD versus brain-dead donors [donation after brain death (DBD)] only and DCD versus DBD transplant, respectively. Propensity matching and competingrisks regression was used to model waitlist outcomes. Survival was modeled using propensity matching and Kaplan-Meier and Cox regression analysis. Results: DCD transplant volumes have increased significantly across all organs. Liver candidates listed for DCD organs were more likely to undergo transplantation compared with propensity-matched candidates listed for DBD only, and heart and liver transplant candidates listed for DCD were less likely to experience death or clinical deterioration requiring waitlist inactivation. Propensity-matched DCD recipients demonstrated an increased mortality risk up to 5 years after liver and kidney transplantation and up to 3 years after lung transplantation compared with DBD. There was no difference in 1-year mortality between DCD and DBD heart transplantation. Conclusions: DCD continues to expand access to transplantation and improves waitlist outcomes for liver and heart transplant candidates. Despite an increased risk for mortality with DCD kidney, liver, and lung transplantation, survival with DCD transplant remains acceptable.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 70%

mentioning

confidence: 99%

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Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

et al. 2023

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“…Annual liver transplantation volume continues to increase year by year, including a record number of 9234 liver transplants performed in the United States in 2021, increased from 8906 transplants in 2020. 1,2 An understanding and anticipation of potential complications of liver transplantation is integral to the medical and interventional management of postoperative patients. Biliary complications are the most common in these patients, with an estimated prevalence of 15% to 45% and an associated mortality rate of about 10%.…”

mentioning

confidence: 99%

“…Liver transplantation continues to be an optimal treatment choice for end-stage liver disease, acute liver failure, and primary liver cancer. Annual liver transplantation volume continues to increase year by year, including a record number of 9234 liver transplants performed in the United States in 2021, increased from 8906 transplants in 2020 1,2. An understanding and anticipation of potential complications of liver transplantation is integral to the medical and interventional management of postoperative patients.…”

mentioning

confidence: 99%

Biliary Complications After Liver Transplantation

Pierce,

Hendzel

et al. 2023

Contemporary Diagnostic Radiology

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Liver transplantation continues to be an optimal treatment choice for end-stage liver disease, acute liver failure, and primary liver cancer. An understanding and anticipation of potential complications of liver transplantation is integral to the medical and interventional management of these postoperative patients. Complications related to the biliary system are the most common posttransplant complications. Potential complications include biliary strictures, leakage, intraductal stone/sludge, and biliary cast syndrome. Multiple diagnostic imaging modalities are available including ultrasound, CT angiography, and hepatobiliary iminodiacetic acid scanning for evaluation of the biliary system and associated complications. The approach of interventional access to the biliary system after surgery is tailored based on surgical transplantation techniques. Endoscopic retrograde cholangiopancreatography remains the imaging modality of choice for evaluation and potential therapeutic intervention. If the biliary tree is not accessible by endoscopy due to postsurgical anatomy changes, interventional radiology may play a vital role in complication management and can provide percutaneous transhepatic cholangiography as a less invasive alternative to surgical intervention.

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Considerations for the use of porcine organ donation models in preclinical organ donor intervention research

Heinis,

Merani,

Markin

et al. 2024

Anim Models and Exp Med

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Use of animal models in preclinical transplant research is essential to the optimization of human allografts for clinical transplantation. Animal models of organ donation and preservation help to advance and improve technical elements of solid organ recovery and facilitate research of ischemia–reperfusion injury, organ preservation strategies, and future donor‐based interventions. Important considerations include cost, public opinion regarding the conduct of animal research, translational value, and relevance of the animal model for clinical practice. We present an overview of two porcine models of organ donation: donation following brain death (DBD) and donation following circulatory death (DCD). The cardiovascular anatomy and physiology of pigs closely resembles those of humans, making this species the most appropriate for pre‐clinical research. Pigs are also considered a potential source of organs for human heart and kidney xenotransplantation. It is imperative to minimize animal loss during procedures that are surgically complex. We present our experience with these models and describe in detail the use cases, procedural approach, challenges, alternatives, and limitations of each model.

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OPTN/SRTR 2021 Annual Data Report: Liver

Cited by 118 publications

References 0 publications

Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death

Biliary Complications After Liver Transplantation

Considerations for the use of porcine organ donation models in preclinical organ donor intervention research

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