Transplant Candidate Outcomes After Declining a DCD Liver in the United States.

Area of Science:

• Transplantation immunology
• Organ donation research
• Hepatology

Background:

• Donation after circulatory death (DCD) expands the donor pool for liver transplantation.
• Despite expansion, DCD livers are discarded at high rates.
• The use of DCD livers from older donors or those with comorbidities remains controversial.

Purpose of the Study:

• To evaluate the long-term survival outcomes of liver transplant candidates who accepted DCD liver offers versus those who declined.
• To quantify the survival benefit associated with accepting DCD liver offers, including from higher-risk donors.

Main Methods:

• Analysis of US registry data from 2009-2020.
• Comparison of outcomes between 1564 DCD liver offer acceptors and 16,981 decliners.
• Utilized competing risk framework and Cox regression for survival benefit estimation.

Main Results:

• Within 10 years, 50.9% of decliners died or were removed from the waitlist.
• DCD acceptors had significantly lower 10-year mortality (35.4% vs. 48.9%).
• Accepting DCD offers was associated with a 46% reduction in mortality risk (aHR 0.54).

Conclusions:

• Accepting DCD liver offers provides significant long-term survival benefits for liver transplant candidates.
• These benefits persist even when accepting livers from older donors or donors with comorbidities.
• Increased recovery and utilization of DCD livers should be promoted to improve patient outcomes.