Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory...

Area of Science:

• Transplantation Surgery
• Organ Donation
• Hepatology

Background:

• Donation after circulatory death (DCD) accounts for a significant portion of liver donations in the UK.
• Standardized documentation of retrieval surgery parameters is crucial for analyzing outcomes.
• Understanding factors influencing DCD liver transplant success is vital for improving patient survival.

Purpose of the Study:

• To analyze outcomes of liver transplantation using DCD livers retrieved across different UK centers.
• To assess the impact of donor/recipient risk factors and retrieval techniques on graft survival.
• To identify predictors of graft loss and complications in DCD liver transplantation.

Main Methods:

• Retrospective analysis of 236 DCD liver transplants performed between 2011 and 2016.
• Inclusion of donor and recipient risk factors, and donor retrieval techniques.
• Multivariate analysis to determine the best predictors of overall graft loss.

Main Results:

• A high overall liver injury rate of 27.1% was observed, with a trend towards more injuries in centers with quicker hepatectomy times.
• The UK DCD risk score was the strongest predictor of overall graft loss (P < 0.001).
• Liver retrieval injuries negatively impacted graft survival in high-risk donor-recipient combinations (P = 0.023), and higher risk correlated with ischemic cholangiopathies (P = 0.003).

Conclusions:

• While retrieval injuries pose a risk, especially in high-risk DCD liver transplants, the overall impact of standardized national retrieval practices on outcomes was minimal.
• The UK DCD risk score is a critical factor in predicting graft survival.
• Further refinement of retrieval techniques may be necessary to reduce injury rates and improve outcomes in DCD liver transplantation.