Utilization of livers donated after circulatory death for transplantation – An international comparison

Eden, Janina; Silva, Richard X. Sousa Da; Cortes‐Cerisuelo, Miriam; Croome, Kristopher P.; Carlis, Riccardo De; Hessheimer, Amelia J.; Muller, Xavier; Goeij, Femke H.C. de; Banz, Vanessa; Magini, Giulia; Compagnon, Philippe; Elmer, Andreas; Lauterio, Andrea; Panconesi, Rebecca; Widmer, Jeannette; Dondossola, Daniele; Muiesan, Paolo; Monbaliu, Diethard; Rosmalen, Marieke de Rosner van; Detry, Olivier; Fondevila, Constantino; Jochmans, Ina; Pirenne, Jacques; Immer, Franz F.; Oniscu, Gabriel C.; Jonge, Jeroen de; Lesurtel, Mickaël; Carlis, Luciano De; Taner, Burçin; Heaton, Nigel; Schlegel, Andrea; Dutkowski, Philipp

doi:10.1016/j.jhep.2023.01.025

Cited by 41 publications

(45 citation statements)

References 44 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, there were several instances in which trends were observed that we felt were still potentially meaningful, even though the p ‐value threshold of .05 was not met. Finally, our study period does not capture the recent continued increase DCD use and greater availability of allograft machine perfusion, which may allow for significantly improved DCD outcomes 21–24 . We anticipate that our results, which highlight the center‐wide benefits of DCD expansion, would still be relevant today, and perhaps of even greater interest given these ongoing trends in DCD LT.…”

Section: Discussionmentioning

confidence: 97%

Center expansion of liver transplants using donation after circulatory death organs is associated with reduced overall waitlist mortality

Kathawate

Abt

Bittermann

2023

Clinical Transplantation

View full text Add to dashboard Cite

Introduction Waitlist outcomes in liver transplantation (LT) for individual recipients are improved by use of allografts procured through donation after circulatory death (DCD). However, the impact of increased DCD acceptance on overall center outcomes is unknown. Methods Using the United Network for Organ Sharing database, 88 centers performing an average of ≥10 LTs/year between 1/2004 and 12/2019 were compared by percent DCD use quartile and categorized into four phenotypes according to temporal usage trends. Overall center median Model for End‐stage Liver Disease at LT (MMaT), waitlist mortality, and waiting time were evaluated. Results The overall DCD rate was 6.1% (N = 4906/80,709), ranging from 0% to 25.5%. Centers in the top DCD use quartile had lower MMaT (24 vs. 26; p < .001) and shorter overall waiting times (median 66 days vs. 90 days; p < .001) compared to bottom quartile centers. MMaT increased less over time at centers with increasing DCD use and was lower than at centers with declining DCD use (27 vs. 32; p = .017). Overall waitlist mortality between 2016 and 2019 was lower at increasing DCD use centers (17.8% vs. 22.5%, p = .034), yet did not affect 1‐year mortality (p = .747). Conclusions The improved waitlist outcomes at centers with expanded DCD use extend beyond DCD recipients alone without negative consequences to overall post‐LT center metrics.

show abstract

Section: Discussionmentioning

confidence: 97%

Center expansion of liver transplants using donation after circulatory death organs is associated with reduced overall waitlist mortality

Kathawate

Abt

Bittermann

2023

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…1,2 A common marginal graft encountered in clinical practice comes from donation after circulatory death (DCD): a donor who has suffered devastating and irreversible brain injury and may be near death but does not meet formal brain death criteria. 3 DCD livers are a critically underutilized resource, 4,5 increasing only slightly from 5% of all deceased-donor LTs in 2009 to 8.5% in 2019. 6 Despite a profound need for organs, nearly 29.9% of DCD livers procured for transplant are discarded, 4 times more than donation after brain death (DBD) livers (7.1%).…”

Section: Introductionmentioning

confidence: 99%

Transplant Candidate Outcomes After Declining a DCD Liver in the United States

Ishaque,

Eagleson,

Bowring

et al. 2023

Transplantation

View full text Add to dashboard Cite

Background. In the context of the organ shortage, donation after cardiac death (DCD) provides an opportunity to expand the donor pool. Although deceased-donor liver transplantation from DCD donors has expanded, DCD livers continue to be discarded at elevated rates; the use of DCD livers from older donors, or donors with comorbidities, is controversial. Methods. Using US registry data from 2009 to 2020, we identified 1564 candidates on whose behalf a DCD liver offer was accepted (“acceptors”) and 16 981 candidates on whose behalf the same DCD offers were declined (“decliners”). We characterized outcomes of decliners using a competing risk framework and estimated the survival benefit (adjusted hazard ratio [95% confidence interval]) of accepting DCD livers using Cox regression. Results. Within 10 y of DCD offer decline, 50.9% of candidates died or were removed from the waitlist before transplantation with any type of allograft. DCD acceptors had lower mortality compared with decliners at 10 y postoffer (35.4% versus 48.9%, P < 0.001). After adjustment for candidate covariates, DCD offer acceptance was associated with a 46% reduction in mortality (0.54 [0.49–0.61]). Acceptors of older (age ≥50), obese (body mass index ≥30), hypertensive, nonlocal, diabetic, and increased risk DCD livers had 44% (0.56 [0.42–0.73]), 40% (0.60 [0.49–0.74]), 48% (0.52 [0.41–0.66]), 46% (0.54 [0.45–0.65]), 32% (0.68 [0.43–1.05]), and 45% (0.55 [0.42–0.72]) lower mortality risk compared with DCD decliners, respectively. Conclusions. DCD offer acceptance is associated with considerable long-term survival benefits for liver transplant candidates, even with older DCD donors or donors with comorbidities. Increased recovery and utilization of DCD livers should be encouraged.

show abstract

“…The benefits of liver perfusion are vast, including transplantation of 50.0%–71.0% of discarded livers, 16,18 improvement in cold 19,20 and donor warm ischemic time, 21 reducing ischemic cholangiopathy, 22 and 94% 1-year overall graft survival 23 . In the United States, liver perfusion has the potential to increase the number of transplantable livers from high-risk donors 16,24 and address long cold ischemic time that might result from long-distance travel between centers 25 …”

Section: Introductionmentioning

confidence: 99%

Geographic disparities in access to liver transplantation

Yilma

Dalal

Wadhwani

et al. 2023

Liver Transplantation

View full text Add to dashboard Cite

Since the Final Rule regarding transplantation was published in 1999, organ distribution policies have been implemented to reduce geographic disparity. While a recent change in liver allocation, termed acuity circles, eliminated the donor service area as a unit of distribution to decrease the geographic disparity of waitlisted patients to liver transplantation, recently published results highlight the complexity of addressing geographic disparity. From geographic variation in donor supply, as well as liver disease burden and differing model for end-stage liver disease (MELD) scores of candidates and MELD scores necessary to receive liver transplantation, to the urban-rural disparity in specialty care access, and to neighborhood deprivation (community measure of socioeconomic status) in liver transplant access, addressing disparities of access will require a multipronged approach at the patient, transplant center, and national level. Herein, we review the current knowledge of these disparities—from variation in larger (regional) to smaller (census tract or zip code) levels to the common etiologies of liver disease, which are particularly affected by these geographic boundaries. The geographic disparity in liver transplant access must balance the limited organ supply with the growing demand. We must identify patient-level factors that contribute to their geographic disparity and incorporate these findings at the transplant center level to develop targeted interventions. We must simultaneously work at the national level to standardize and share patient data (including socioeconomic status and geographic social deprivation indices) to better understand the factors that contribute to the geographic disparity. The complex interplay between organ distribution policy, referral patterns, and variable waitlisting practices with the proportion of high MELD patients and differences in potential donor supply must all be considered to create a national policy strategy to address the inequities in the system.

show abstract

Utilization of livers donated after circulatory death for transplantation – An international comparison

Cited by 41 publications

References 44 publications

Center expansion of liver transplants using donation after circulatory death organs is associated with reduced overall waitlist mortality

Center expansion of liver transplants using donation after circulatory death organs is associated with reduced overall waitlist mortality

Transplant Candidate Outcomes After Declining a DCD Liver in the United States

Geographic disparities in access to liver transplantation

Contact Info

Product

Resources

About