Attitudes and barriers to the use of DCD livers: Comparison of a U.S. transplant center survey to the United Network for Organ Sharing data.

5 years ago

Attitudes and barriers to the use of DCD livers: Comparison of a U.S. transplant center survey to the United Network for Organ Sharing data.

Case J, Abt P, Quintini C, Marsh CL, Groshen S, Yan P, Lo M, Fayek SA, Sher L, Ji L

Transplantation of liver grafts from donation after circulatory death (DCD) is limited. To identify barriers of DCD livers utilization, all active United States (U.S.) liver transplant centers (n=138) were surveyed and responses compared to the United Network for Organ Sharing (UNOS) data. Seventy-four centers (54%) responded, and diversity in attitudes was observed, with many not using organ and/or recipient prognostic variables defined in prior studies and UNOS data analysis. Most centers (74%) believed lack of a system allowing a timely re-transplant is a barrier to utilization. UNOS data demonstrated worse 1 and 5 year patient- and graft survival in DCD (86% and 64% and 82% and 59% respectively) versus donation after brain death (DBD) recipients (90% and 71% and 88% and 69% respectively). Donor alanine aminotransferase (ALT), recipient model for end-stage liver disease (MELD) and cold ischemia time (CIT) significantly impacted DCD outcomes to a greater extent than DBD outcomes. At 3 years, relisting and re-transplant rates were 7.9% and 4.6% higher in DCD recipients. To optimize outcome our data supports the use of DCD liver grafts with CIT <6-8 hours in patients with MELD ≤20. In conclusion, standardization of donor and recipient criteria, defining the impact of ischemic cholangiopathy, addressing donor hospital policies, and developing a strategy for timely re-transplant may help to expand the use of these organs. This article is protected by copyright. All rights reserved.

Publisher URL: https://www.ncbi.nlm.nih.gov/pubmed/28834180

DOI: PubMed:28834180