Evolving utilization of donation after circulatory death livers in liver transplantation: The day of DCD has come

Area of Science:

• Transplantation immunology
• Organ procurement and utilization
• Hepatobiliary surgery

Background:

• Donation after circulatory death (DCD) livers face challenges like ischemia-reperfusion injury and ischemic cholangiopathy due to warm ischemic time (WIT).
• Historically, DCD liver utilization for liver transplantation (LT) was restricted to donors with short WITs and younger age, leading to organ discard.

Purpose of the Study:

• To evaluate trends in DCD liver utilization and transplant outcomes over time.
• To assess the impact of increasing clinical experience on DCD liver allograft use and patient results.

Main Methods:

• Analysis of adult, first-time, deceased donor, whole-organ liver transplant data from the Organ Procurement and Transplantation Network (OPTN).
• Study period: January 1995 to December 2019.
• Comparison of outcomes between donation after brain death (DBD) and DCD liver transplants.

Main Results:

• Increased clinical experience has led to greater utilization of DCD livers for LT.
• DCD liver transplants showed shorter ischemic times, reduced post-transplant hospitalization, and lower retransplantation rates.
• The rate of DCD LTs in the US has grown faster than DBD LTs over the last decade.

Conclusions:

• Growing experience with DCD liver transplantation is improving outcomes and increasing organ utilization.
• DCD liver allografts represent a significant, underutilized resource to combat liver transplant organ shortages.
• Further optimization of DCD liver procurement and transplantation protocols can expand the donor pool.