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Updated: Nov 10, 2025
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Donation after circulatory death liver transplantation: An in-depth analysis and propensity score-matched comparison
Mark J Hobeika1,2,3, Ashish Saharia1,2, Constance M Mobley1,2
1Department of Surgery, J.C. Walter, Jr. Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist, Houston, Texas, USA.
Insights
Outcomes for liver transplantation using donation after circulatory death (DCD) donors are comparable to donation after brain death (DBD) donors, even in high-acuity recipients. Careful matching and minimizing ischemia time are crucial for successful DCD liver transplants.
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Donation
Background:
- Donation after circulatory death (DCD) liver transplantation (LT) outcomes have improved with better donor-recipient matching and reduced ischemia times.
- This study evaluates DCD LT in a single center, including critically ill and hospitalized patients.
Purpose of the Study:
- To compare the outcomes of DCD LT with donation after brain death (DBD) LT.
- To assess the safety and efficacy of DCD LT in high-acuity recipients.
Main Methods:
- A propensity score-matched (PSM) analysis compared 32 DCD LT recipients with 128 PSM DBD LT recipients from 2008 to 2018.
- Kaplan-Meier estimates and Cox proportional hazards models were used to analyze patient and graft survival.
Main Results:
- No significant differences in 3-year patient or graft survival were observed between DCD LT and PSM DBD LT cohorts.
- DCD was not an independent risk factor for mortality or graft loss.
- Severe acute kidney injury post-transplant was similar; ischemic-type biliary lesions (ITBL) occurred in 6.3% of DCD LT recipients.
Conclusions:
- DCD LT can achieve outcomes similar to DBD LT, even in high-acuity patients.
- Low rates of ITBL were observed in the DCD LT group.
- Strict donor selection, minimized ischemia, and avoiding futile transplants are key for successful DCD LT.
Background:
Careful donor-recipient matching and reduced ischemia times have improved outcomes following donation after circulatory death (DCD) liver transplantation (LT). This study examines a single-center experience with DCD LT including high-acuity and hospitalized recipients.
Methods:
DCD LT outcomes were compared to a propensity score-matched (PSM) donation after brain death (DBD) LT cohort (1:4); 32 DCD LT patients and 128 PSM DBD LT patients transplanted from 2008 to 2018 were included. Analyses included Kaplan-Meier estimates and Cox proportional hazards models examining patient and graft survival.
Results:
Median MELD score in the DCD LT cohort was 22, with median MELD of 27 for DCD LT recipients with decompensated cirrhosis. No difference in mortality or graft loss was found (p < .05) between DCD LT and PSM DBD LT at 3 years post-transplant, nor was DCD an independent risk factor for patient or graft survival. Post-LT severe acute kidney injury was similar in both groups. Ischemic-type biliary lesions (ITBL) occurred in 6.3% (n = 2) of DCD LT recipients, resulting in 1 graft loss and 1 death.
Conclusion:
This study supports that DCD LT outcomes can be similar to DBD LT, with a low rate of ITBL, in a cohort including high-acuity recipients. Strict donor selection criteria, ischemia time minimization, and avoiding futile donor/recipient combinations are essential considerations.
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