Current status of donation after cardiac death liver transplantation

Abstract

The article reviews the current state of liver transplantation using allografts from donation after cardiac death (DCD), focusing on single and multicenter outcomes, best practice guidelines and emerging strategies to optimize utilization of this precious resource. DCD is being embraced as one effective way to solve the organ shortage and is contributing the largest increase to the pool of liver allografts. However, ischemic cholangiopathy and substandard graft survival remain significant risks for recipients of DCD livers. Risk factors for poor outcome after DCD liver transplant (LTX) are being identified, including older donor age and longer ischemia times. Emerging practice guidelines for DCD LTX focus on donor criteria, consent, withdrawal of support, operative technique, ischemia times, recipient considerations, and biliary issues. Research is under way to further identify risk factors for DCD LTX and strategies to protect against ischemic injury, and there are efforts to standardize procurement protocols, refine data reporting and facilitate multicenter research collaboration. Livers from DCD remain a partially tapped resource for patients who require transplantation. Although some centers have successful experiences with DCD LTX, there are challenges unique to this endeavor. Donor and recipient selection criteria, perioperative factors and surgical technique are each critical aspects of DCD LTX. It is important to continue to develop this field so that more DCD LTX can be safely performed.