Safely Expanding the Liver Donor Pool by Utilization of Organs from Donation after Circulatory Death with Comparable Results to Donation After Brain Death, a Large Single-Center Experience

Outcomes of Liver Transplantation From Hepatitis C Virus-positive DCD Donors and Its Utilization Among Centers in the United States

BACKGROUND

Donation after circulatory death (DCD) or hepatitis C virus (HCV + ) liver grafts are underused among transplant centers in the United States. The study aimed to evaluate organ utilization and outcomes of liver grafts from DCD donors with HCV infection.

METHODS

National registry and local center data of all deceased donor liver transplants performed between November 2016 and December 2021 were analyzed. All transplants were divided into 4 groups: HCV - DCD, HCV - donation after brain death [DBD], HCV + DCD, and HCV + DBD. The outcome of interest was 1-y graft survival.

RESULTS

Out of 146 liver transplant centers in the United States, liver transplants were not performed from DCD donors, HCV + donors, and a combination of DCD and HCV + donors by 28.7%, 27%, and 70%-72% of centers, respectively. In multivariate analysis, increasing center acceptance ratio was associated with increased utilization of liver grafts from DCD HCV - and DCD HCV antibody-positive nucleic acid test negative donors. Nationally, 1-y graft survival of HCV - DCD liver grafts was lower compared with other groups (89% versus 92% HCV + DCD versus 93% HCV + DBD versus 92% HCV - DBD, log rank P  < 0.0001). There was no difference in 1-y graft survival among groups locally.

CONCLUSIONS

Liver grafts from HCV + DCD donors have 1-y patient and graft survival comparable with DBD liver grafts from donors with or without HCV infection. These results encourage the widespread use of liver grafts from DCD and HCV + donors and standardization of practice in DCD donation to expand the donor pool without compromising short-term outcomes.

The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres

BACKGROUND

As literature largely focuses on long-term outcomes, this study aimed at elucidating the perioperative outcomes of liver transplant patients receiving a graft from two groups of unconventional expanded criteria donors: brain dead aged > 80 years and cardiac dead.

METHODS

Data of 247 cirrhotic patients transplanted at two high volume liver transplant centers were analysed. Confounders were balanced using a stabilized inverse probability therapy weighting and a propensity score for each patient on the original population was generated. The score was created using a multivariate logistic regression model considering a Comprehensive Complication Index ≥ 42 (no versus yes) as the dependent variable and 11 possible clinically relevant confounders as covariate.

RESULTS

Forty-four patients received the graft from a cardiac-dead donor and 203 from a brain-dead donor aged > 80 years. Intraoperatively, cardiac-dead donors liver transplant cases required more fresh frozen plasma units (P < 0.0001) with similar reduced need of fibrinogen to old brain-dead donors cases. The incidence of reperfusion syndrome was similar (P = 0.80). In the Intensive Care Unit, both the groups presented a comparable low need for blood transfusions, renal replacement therapy and inotropes. Cardiac-dead donors liver transplantations required more time to tracheal extubation (P < 0.0001) and scored higher Comprehensive Complication Index (P < 0.0001) however the incidence of a severe complication status (Comprehensive Complication Index  ≥ 42) was similar (P = 0.52). ICU stay (P = 0.97), total hospital stay (P = 0.57), in hospital (P = 1.00) and 6 months (P = 1.00) death were similar.

CONCLUSION

Selected octogenarian and cardiac-dead donors can be used safely for liver transplantation.