Donation after Circulatory Death Grafts Have Comparable Outcomes to Donation after Brain Death Grafts in Liver Transplantation

Abstract

Introduction: In the United States, 30% of donation after circulatory death (DCD) grafts are discarded for liver transplantation (LT). DCD grafts can mitigate liver organ shortage but is underused due to the believe of poor outcomes in graft and patient survival. Recent studies have shown comparable outcomes to donation after brain death (DBD). The aim of this study is to review our experience with the use of DCD grafts. Methods: Retrospective single center study, whole grafts transplanted between January 2014 and December 2021 were included. Propensity score match was done using recipient age, recipient gender, MELD score, wait time, number of previous LT, cold ischemia time, year of LT and surgeon as cofounders. Multivariate Cox-regression models were created with significant variables in the univariate analysis. Finally, Kaplan-Meier curves with log-rank test were performed. Results: A total of 63 DCD and 148 DBD grafts were included. The patients were predominantly males (59.2%), median age was 58 (IQR 49-65), the most common reason for transplantation was alcoholic cirrhosis (20.4%) and were listed for their first LT (95.7%). Number of transplants (HR:15.39, 95%CI: 3.56-66.49, p < 0.001) and BMI (HR:1.1, 95%CI: 1.01-1.2, p = 0.03) were associated to graft loss. DCD was not associated with graft (HR:0.47, 95%CI: 0.14-1.58, p = 0.2) or patient (HR:0.33, 95%CI: 0.08-1.42, p = 0.1) survival. Graft (92.9% DBD vs 96.8% DCD, p = 0.2) and patient (93.6% DBD vs 100% DCD, p = 0.1) 2-year survival were similar. Conclusion: When matching different cofounders, the use of DCD grafts has comparable outcomes to those DBD grafts.