United States donation after circulatory death liver transplantation is driven by a few high-utilization transplant centers

Hobeika, Mark J.; Menser, Terri; Nguyen, Duc T.; Beal, Lauren L.; Zajac, Stephanie; Graviss, Edward A.

doi:10.1111/ajt.15629

Cited by 36 publications

(38 citation statements)

References 5 publications

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“…Almost 95% of the older (≥70 years) DCD allografts were used in two regions: group 1 subjects were clustered in London (53.6%) and West Midlands (40.6%; p < .001), where the two highest DCD volume centers, King's College (London) and Queen Elizabeth Hospitals (Birmingham, West Midlands) are located. An observation perhaps in agreement with recent reports on positive association of increasing center volume with aggressiveness in organ acceptance, while keeping waitlist times short and outcomes comparable 39,40 . Our data have shown a dynamic of “regionalization” in the marginal graft utilization.…”

Section: Discussionsupporting

confidence: 93%

Comparable graft survival is achievable with the usage of donation after circulatory death liver grafts from donors at or above 70 years of age: A long-term UK national analysis

Giorgakis

Khorsandi

Mathur³

et al. 2021

American Journal of Transplantation

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The aim of the study was to assess the UK donation after circulatory death (DCD) liver transplant experience from donors ≥70 years. Nationwide UK DCD retrospective analysis was conducted between 2001 and 2015 (n = 1163). Recipients were divided into group 1 vs. group 2 (donors 70≥ vs. <70 years, respectively). group 1 (n = 69, 5.9%) recipients were older (median 59 vs. 55 years, p = .001) and had longer waitlist time (128 vs. 84 days; p = .039). 94.2% of group 1 clustered in London and Birmingham, where the two busiest centers are located. group 1 allografts had higher UKDRI and UK DCD Risk Scores but similar WIT and CIT and were more likely to have been imported. Both groups had similar 1‐, 3‐, and 5‐year graft survival (group 1, 90%, 81.4%, and 74% vs. group 2, 88.6%, 81.4%, and 78.6%, respectively; p = .54). Both groups had similar ICU stay length (p = .22), 3‐month hepatic artery thrombosis rates (4.4% vs 4.0%; p = .9), and 12‐month readmission rates for all biliary complications (20.3% vs 25.7%; p = .32). This study demonstrates that acceptable outcomes are achievable using older grafts in a highly selected cohort at experienced centers. Advanced age should not be an absolute contraindication to utilizing a DCD graft from donors aged ≥70 years.

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Section: Discussionsupporting

confidence: 93%

Comparable graft survival is achievable with the usage of donation after circulatory death liver grafts from donors at or above 70 years of age: A long-term UK national analysis

Giorgakis

Khorsandi

Mathur³

et al. 2021

American Journal of Transplantation

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“…Hobeika et al showed that only 3 centers in the United States performed over 100 DCD LTs during a 5‐year study period between January 2013 to December 2017, and this comprised 17.5% of all DCD LTs in the United States. The authors conjecture that understanding high‐utilization center practices and their relationships with Organ Procurement Organizations could help minimize the variation in DCD LT volume and practice 43 . It is also possible that with broader sharing of DCD livers, the greater regional competition for organs will increase DCD use in those areas.…”

Section: Discussionmentioning

confidence: 99%

Evolving utilization of donation after circulatory death livers in liver transplantation: The day of DCD has come

Haque

Yuan

Uygun

et al. 2021

Clinical Transplantation

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Compared to donation after brain death (DBD), livers procured for transplantation from donation after circulatory death (DCD) donors experience more ischemia‐reperfusion injury and higher rates of ischemic cholangiopathy due to the period of warm ischemic time (WIT) following withdrawal of life support. As a result, utilization of DCD livers for liver transplant (LT) has generally been limited to short WITs and younger aged donor grafts, causing many recovered DCD organs to be discarded without consideration for transplant. This study assesses how DCD liver utilization and outcomes have changed over time, using OPTN data from adult, first‐time, deceased donor, whole‐organ LTs between January 1995 and December 2019. Results show that increased clinical experience with DCD LT has translated into increased use of livers from DCD donors, shorter ischemic times, shorter lengths of hospitalization after transplant, and lower rates of retransplantation. The data also reveal that over the past decade, the rate of increase in DCD LTs conducted in the United States has outpaced that of DBD. Together, these trends signal an opportunity for the field of liver transplantation to mitigate the organ shortage by capitalizing on DCD liver allografts that are currently not being utilized.

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“…This variability in DCD liver utilization has been shown to have no correlation with median MELD score at transplant [ 13 •• ]. Indeed, it is known that DCD utilization in the USA is driven by a few high-utilization centers [ 14 ]. Likely, the new allocation changes will result in significant changes to behavior both from transplant centers as well as OPOs with regard to the pursuit and utilization of DCD livers.…”

Section: Changes To Allocation and Effects On Dcd Liver Transplantatimentioning

confidence: 99%

The Changing Landscapes in DCD Liver Transplantation

Croome

Taner

2020

Curr Transpl Rep

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Purpose of Review The transplant community continues to look for ways to help address the discordance between donor liver graft availability and patients on the liver transplant waiting list. Donation after circulatory death (DCD) donor livers represents one potential means to help address this discordance. The present review describes the changing landscape of DCD liver transplantation (LT). Recent Findings The number of DCD LTs performed annually within the USA has continued to grow on an annual basis. Importantly, national data has demonstrated that outcomes with DCD LT have been improving. This improvement has been driven by better understanding of how to successfully utilize these organs through better donor and recipient matching and careful evaluation of both hemodynamics during withdrawal of life support and the refinement of the procurement operation. Summary Despite these improvements in outcome, ischemic cholangiopathy (IC) continues to be the Achilles heel of DCD LT. Emerging technologies such as various forms of machine perfusion may allow for reduction of complications and better prognostication of the risk associated with DCD liver grafts.

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United States donation after circulatory death liver transplantation is driven by a few high-utilization transplant centers

Cited by 36 publications

References 5 publications

Comparable graft survival is achievable with the usage of donation after circulatory death liver grafts from donors at or above 70 years of age: A long-term UK national analysis

Comparable graft survival is achievable with the usage of donation after circulatory death liver grafts from donors at or above 70 years of age: A long-term UK national analysis

Evolving utilization of donation after circulatory death livers in liver transplantation: The day of DCD has come

The Changing Landscapes in DCD Liver Transplantation

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