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Published on: August 17, 2022
Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score-Matched Study From a
Summary
Liver transplants using donation after circulatory death (DCD) grafts, even marginal ones, show comparable patient and graft survival to donation after brain death (DBD) grafts. Careful recipient selection is key for safe DCD liver transplantation.
Area of Science:
- Transplantation Medicine
- Hepatology
- Organ Donation
Background:
- The utilization of liver grafts from donation after circulatory death (DCD) donors is rising.
- Concerns persist regarding the outcomes of liver transplants utilizing grafts from "marginal" donors, including those from DCD sources.
Purpose of the Study:
- To compare the outcomes of liver transplantation using DCD grafts versus donation after brain death (DBD) grafts.
- To evaluate the safety and efficacy of marginal DCD liver grafts in comparison to DBD grafts.
Main Methods:
- Propensity score matching was employed for 973 patients undergoing primary whole-liver transplantation between 2004 and 2014.
- Analysis focused on overall graft and patient survival, alongside postoperative complications, biliary issues, and vascular complications.
Main Results:
- No significant differences in overall graft or patient survival were observed between matched DCD and DBD groups (p = 0.162 and p = 0.519).
- DCD recipients experienced higher incidences of acute kidney injury (32.6% vs. 15%) and ischemic cholangiopathy (9.1% vs. 1.1%).
- Aspartate aminotransferase levels were elevated in DCD recipients up to 48 hours post-transplant.
Conclusions:
- Liver transplantation using DCD grafts, including those classified as marginal, can achieve outcomes comparable to DBD grafts.
- Appropriate recipient selection is crucial for ensuring the safety and success of DCD liver transplants.
