Related Experiment Video
Updated: Nov 17, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Conditional probability of graft survival in liver transplantation using donation after circulatory death grafts - a
Kazunari Sasaki1, Amit Nair1, Daniel J Firl2
1Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA.
Insights
Donation after circulatory death (DCD) liver transplants show worse graft survival and higher biliary complication rates than donation after brain death (DBD) livers, even years post-transplant. Careful DCD graft selection is crucial for better long-term outcomes.
Area of Science:
- Transplantation Medicine
- Hepatology
- Organ Donation
Background:
- Donation after circulatory death (DCD) liver grafts historically have higher rates of biliary complications and lower short-term graft survival (GS) compared to donation after brain death (DBD) allografts.
- The long-term prognostic impact of DCD livers after initial post-transplant survival remains incompletely understood.
Purpose of the Study:
- To dynamically evaluate the prognostic impact of DCD livers in liver transplantation (LT).
- To determine if DCD livers remain an adverse factor beyond the early post-transplant period.
Main Methods:
- Analysis of 74,961 LT recipients (4,065 DCD LT) from the Scientific Registry of Transplant Recipients (2002-2017).
- Calculation of conditional hazard ratios (HR) for 1-year graft survival using a conditional Cox regression model.
- Graft loss analysis focusing on biliary complications.
Main Results:
- Actual 1-, 3-, and 5-year GS for DCD LT recipients were significantly worse than DBD (83.3%, 73.3%, 66.3% vs. DBD).
- Conditional HR of 1-year GS for DCD vs. DBD livers were 1.87 (actual), 1.49 (1-year conditional), and 1.39 (3-year conditional).
- Biliary complications were significantly higher in the DCD group, persisting beyond 3 years post-LT.
Conclusions:
- DCD liver grafts present protracted higher risks compared to DBD grafts, even after successful early post-transplant survival.
- Long-term risks, particularly biliary complications, necessitate careful DCD graft selection at the center level to optimize patient outcomes.
Abstract:
The use of livers from donation after circulatory death (DCD) is historically characterized by increased rates of biliary complications and inferior short-term graft survival (GS) compared to donation after brain death (DBD) allografts. This study aimed to evaluate the dynamic prognostic impact of DCD livers to reveal whether they remain an adverse factor even after patients survive a certain period following liver transplant (LT). This study used 74 961 LT patients including 4065 DCD LT in the scientific registry of transplant recipients from 2002-2017. The actual, 1 and 3-year conditional hazard ratio (HR) of 1-year GS in DCD LT were calculated using a conditional version of Cox regression model. The actual 1-, 3-, and 5-year GS of DCD LT recipients were 83.3%, 73.3%, and 66.3%, which were significantly worse than those of DBD (all P < 0.01). Actual, 1-, and 3-year conditional HR of 1-year GS in DCD compared to DBD livers were 1.87, 1.49, and 1.39, respectively. Graft loss analyses showed that those lost to biliary related complications were significantly higher in the DCD group even 3 years after LT. National registry data demonstrate the protracted higher risks inherent to DCD liver grafts in comparison to their DBD counterparts, despite survival through the early period after LT. These findings underscore the importance of judicious DCD graft selection at individual center level to minimize the risk of long-term biliary complications.
