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Updated: Jun 20, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Liver transplantation using controlled donation after cardiac death donors: an analysis of a large single-center
Hani P Grewal1, Darrin L Willingham, Justin Nguyen
1Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA. grewal.hani@mayo.edu
Insights
Donation after cardiac death (DCD) liver transplants show excellent long-term survival, comparable to donation after brain death (DBD) organs. This study demonstrates DCD allografts are a viable and effective option for liver transplantation.
Area of Science:
- Transplantation immunology
- Hepatobiliary surgery
- Organ donation research
Background:
- Donation after cardiac death (DCD) donors offer a potential organ source for liver transplantation.
- Concerns about primary nonfunction (PNF) and intrahepatic biliary strictures (IHBSs) have historically limited DCD donor utilization.
- Limited data exists comparing long-term outcomes of DCD versus donation after brain death (DBD) liver allografts.
Purpose of the Study:
- To compare the long-term patient and graft survival rates of liver transplants using DCD donors versus DBD donors.
- To evaluate the incidence of primary nonfunction (PNF) and intrahepatic biliary strictures (IHBSs) in DCD liver allografts.
- To assess the impact of donor age on outcomes in DCD liver transplantation.
Main Methods:
- Retrospective analysis of 1436 deceased donor liver transplants (December 1998 - October 2006).
- Comparison of 108 DCD liver transplants with 1328 DBD liver transplants.
- Median follow-up of 48 months, analyzing patient and graft survival, and causes of graft loss.
Main Results:
- 1-, 3-, and 5-year patient survival for DCD donors: 91.5%, 88.1%, 88.1%; graft survival: 79.3%, 74.5%, 71.0%.
- 1-, 3-, and 5-year patient survival for DBD donors: 87.3%, 81.1%, 77.2%; graft survival: 81.6%, 74.7%, 69.1%.
- No significant difference in patient or graft survival between DCD (younger/older than 60) and DBD donors. IHBSs (n=9) and PNF (n=4) were noted causes of graft loss.
Conclusions:
- Liver transplantation using DCD allografts achieves excellent long-term patient and graft survival.
- Outcomes of DCD liver allografts are equivalent to those of DBD allografts.
- DCD donors represent a valuable and effective source for liver transplantation, challenging previous concerns.
Abstract:
The use of donation after cardiac death (DCD) donors may provide a valuable source of organs for liver transplantation. Concerns regarding primary nonfunction (PNF) and intrahepatic biliary stricture (IHBSs) have limited the enthusiasm for their use. A retrospective analysis of 1436 consecutive deceased donor liver transplants performed between December 1998 and October 2006 was conducted. These included 108 DCD liver transplants, which were compared to 1328 transplants performed with organs from donors meeting the criteria for donation after brain death (DBD). The median follow-up was 48 months. The 1-, 3-, and 5-year patient survival and graft survival for DCD donors were 91.5%, 88.1%, and 88.1% and 79.3%, 74.5%, and 71.0%, respectively. The 1-, 3-, and 5-year patient survival and graft survival for DBD donors were 87.3%, 81.1%, and 77.2% and 81.6%, 74.7%, and 69.1%, respectively. Patient survival and graft survival were not significantly different between DCD donors less than 60 years old, DCD donors greater than 60 years old, and DBD donors. Causes of graft loss included IHBSs (n = 9), PNF (n = 4), recurrent hepatitis C virus (n = 4), hepatic artery thrombosis (n = 1), rejection (n = 2), and patient death (n = 13). Contrary to previously published data, excellent long-term patient survival and graft survival can be obtained with DCD allografts, and in our experience, they are equivalent to those obtained from DBD allografts.
