Donation after circulatory death and liver transplantation: a cohort study

Area of Science:

• Transplantation immunology
• Organ donation research
• Surgical outcomes

Background:

• Donations after circulatory death (DCD) present challenges in Italy, including extended warm ischemia time (tWIT) due to legal and logistical factors.
• Understanding the impact of different DCD types on transplantation success is crucial for optimizing organ utilization.

Purpose of the Study:

• To assess the association between successful liver transplantation and DCD types within the North Italy Transplant program.
• To compare the outcomes of type III versus type II DCD liver donations.

Main Methods:

• A cohort study included consecutive DCD cases from 2008 to 2020.
• Poisson regression with robust error variance was used to estimate adjusted risk ratios (RR) and 95% confidence intervals (CIs).
• Analysis focused on liver eligibility, recovery, and transplantation rates, controlling for warm ischemia time (tWIT).

Main Results:

• Type III DCD livers had a higher likelihood of being transplanted (RR: 1.49; 95% CI: 1.01-2.19) compared to type II.
• Livers from type III DCD were recovered more frequently (75%) than from type II (64%).
• The difference in transplant rates diminished after controlling for tWIT, suggesting its significant role.

Conclusions:

• Type III DCD livers demonstrate a greater probability of successful transplantation than type II.
• Warm ischemia time is a critical factor influencing the disparity in transplantation outcomes between DCD types.
• Optimizing strategies to minimize tWIT is essential for improving DCD liver transplantation in Italy.