Related Experiment Video
Updated: Apr 21, 2026
Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
Donation after cardiac death liver transplantation in primary sclerosing cholangitis: proceed with caution
Vinay Sundaram1, Gina Choi, Christie Y Jeon
11 Division of Gastroenterology and Comprehensive Transplant Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. 2 Department of Internal Medicine, University of California at Los Angeles School of Medicine, Los Angeles, CA. 3 Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, LosAngeles, CA. 4 Department of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA.
Insights
Donation after cardiac death (DCD) liver transplants show worse outcomes for primary sclerosing cholangitis (PSC) patients. Cautious use of DCD organs is recommended for PSC to improve graft survival.
Area of Science:
- Hepatology
- Transplantation Immunology
- Organ Donation
Background:
- Primary sclerosing cholangitis (PSC) patients have comorbidities not addressed by standard liver transplant scoring.
- Donation after cardiac death (DCD) offers an expanded donor pool, potentially benefiting PSC patients.
- The impact of DCD liver transplantation on PSC graft outcomes remains unclear.
Purpose of the Study:
- To investigate the outcomes of DCD liver transplantation in PSC patients.
- To compare graft survival and failure rates between DCD and donation after brain death (DBD) liver transplants in PSC.
- To analyze risk factors for graft failure in PSC patients undergoing liver transplantation.
Main Methods:
- Analysis of 41,018 liver transplant recipients from the United Network for Organ Sharing database (2002-2012).
- Kaplan-Meier analysis for graft survival assessment.
- Cox regression modeling to identify risk factors for graft failure.
Main Results:
- PSC patients receiving DCD livers experienced significantly higher overall graft failure (37.3% vs. 20.4%) and biliary complication-related failure (47.4% vs. 13.9%) compared to those receiving DBD organs.
- While PSC and non-PSC patients had similar graft failure rates among DCD transplants, a trend towards increased biliary complications in PSC patients was observed (47.4% vs. 26.4%).
- Cox modeling revealed PSC patients have better graft survival (HR=0.72), but DCD transplantation increases graft failure risk (HR=1.28). The interaction term (HR=1.76) indicates DCD organs disproportionately worsen outcomes in PSC.
Conclusions:
- DCD liver transplantation is associated with significantly poorer graft outcomes in primary sclerosing cholangitis patients.
- The use of DCD organs in PSC liver transplantation requires careful consideration due to increased risks.
- Further research and cautious application of DCD organs in PSC are warranted.
Background:
Primary sclerosing cholangitis (PSC) patients suffer from comorbidities unaccounted for by the model for end-stage liver disease scoring system and may benefit from the increased donor organ pool provided by donation after cardiac death (DCD) liver transplantation. However, the impact of DCD transplantation on PSC graft outcomes is unknown.
Methods:
We studied 41,018 patients using the United Network for Organ Sharing database from 2002 through 2012. Kaplan-Meier analysis and Cox regression were used to evaluate graft survival and risk factors for graft failure, respectively.
Results:
The PSC patients receiving DCD livers (n=75) showed greater overall graft failure (37.3% vs. 20.4%, P = 0.001), graft failure from biliary complications (47.4% vs. 13.9%, P = 0.002), and shorter graft survival time (P = 0.003), compared to PSC patients receiving donation after brain death organs (n=1592). Among DCD transplants (n=1943), PSC and non-PSC patients showed similar prevalence of graft failure and graft survival time, though a trend existed toward increased biliary-induced graft failure among PSC patients (47.4 vs. 26.4%, P = 0.063). Cox modeling demonstrated that PSC patients have a positive graft survival advantage compared to non-PSC patients (hazard ratio [HR]=0.72, P < 0.001), whereas DCD transplantation increased risk of graft failure (HR = 1.28, P < 0.001). Furthermore, the interaction between DCD transplant and PSC was significant (HR = 1.76, P = 0.015), indicating that use of DCD organs impacts graft survival more in PSC than non-PSC patients.
Conclusion:
Donation after cardiac death liver transplantation leads to significantly worse outcomes in PSC. We recommend cautious use of DCD transplantation in this population.
