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The Implication of Center Volumes in Donation After Circulatory Death for Liver Transplantation: Donor-Recipient
Yuki Bekki1, Yaniv Fenig2, Bryan Myers3
1Recanati-Miller Transplantation Institute, the Icahn School of Medicine at Mount Sinai, New York City, New York.
Insights
Donation after circulatory death liver transplant (DCD LT) outcomes vary by center volume. High-risk donors fare well with low-risk recipients and short cold ischemia time, but high-risk recipients have poorer DCD LT outcomes.
Area of Science:
- Transplant Surgery
- Hepatology
- Organ Donation
Background:
- Donation after circulatory death liver transplant (DCD LT) use and outcomes are improving.
- Limited data exist on practice variations among transplant centers.
Purpose of the Study:
- To analyze how center volume impacts outcomes in DCD LT.
- To investigate the influence of donor and recipient risk factors on DCD LT success.
Main Methods:
- Utilized United Network for Organ Sharing Standard Transplant Analysis and Research data.
- Stratified transplant centers into four volume quartiles (lowest, low, high, highest).
- Analyzed donor/recipient characteristics and one-year graft survival rates.
Main Results:
- High-risk donors (older, obese) increased with center volume; cold ischemia time decreased.
- High-risk recipients showed no significant difference across most quartiles, except the highest.
- One-year graft survival exhibited a bimodal pattern, with highest and low-volume centers performing best.
Conclusions:
- Matching high-risk donors with low-risk recipients and minimizing cold ischemia time improves DCD LT outcomes.
- High-risk recipients may not achieve favorable outcomes in DCD LT, regardless of center experience or shorter cold ischemia time.
Background:
The use of donation after circulatory death liver transplant (DCD LT) has increased and the outcomes have improved. There are little data concerning the details of centers' practice.
Methods:
Using the United Network for Organ Sharing Standard Transplant Analysis and Research data, the centers were stratified into 4 quartiles: lowest-, low-, high-, and highest-volume quartiles.
Results:
High-risk donors, defined as older donors (≥50 years) or obese donors (body mass index ≥ 30 kg/m2), linearly increased in line with the centers' volumes (P < .001), while cold ischemia time (CIT) showed an inverse correlation (P < .001). High-risk recipients, defined as those with high Model for End-stage Liver Disease score, re-LT, inpatient, or ventilator/dialysis before LT, did not show any significant difference (P = .74) except in the highest-volume quartile (P < .001). One-year graft survival showed a bimodal pattern across the 4 quartiles (P = .027): superior graft survival in the highest-volume quartile and in the low-volume quartile and inferior graft survival in the high-volume quartile and in the lowest-volume quartile.
Conclusions:
High-risk donors can achieve satisfactory outcomes by being matched with low-risk recipients and shortening CIT. However, high-risk recipients may not result in favorable outcomes with DCD LT even with centers' experience and shorter CIT.
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