Strategies to Improve the Utilization and Function of DCD Livers

Area of Science:

• Transplantation immunology
• Organ preservation
• Hepatology

Background:

• Donation after circulatory death (DCD) liver allografts are increasingly used, yet many patients remain on transplant waitlists.
• Optimizing the utilization and outcomes of DCD liver allografts is crucial for addressing organ shortages.

Approach:

• This review syntheses recent international literature on strategies to enhance DCD liver allograft utilization and outcomes.
• Key areas explored include donor-recipient matching, perioperative strategies (NRP, rapid controlled DCD recovery), viability assessment of discarded livers, and postoperative interventions (machine perfusion, pharmacologic therapies).

Key Points:

• Advances in machine perfusion (normothermic and hypothermic) and perioperative strategies like normothermic regional perfusion (NRP) show significant potential for increasing DCD liver allograft utilization.
• Graft steatosis and viability testing of extended criteria donors are critical factors influencing DCD liver allograft success.
• European experience with NRP and promising data on higher-risk donor organs suggest wider adoption is feasible.

Conclusions:

• Implementing advanced techniques like machine perfusion and NRP can significantly improve the utilization and outcomes of DCD liver allografts.
• Further research and adoption of these strategies in the United States could expand the donor pool and benefit more patients on liver transplant waitlists.