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Donation after circulatory death liver transplantation: An in‐depth analysis and propensity score–matched comparison
Author(s) -
Hobeika Mark J.,
Saharia Ashish,
Mobley Constance M.,
Menser Terri,
Nguyen Duc T.,
Graviss Edward A.,
McMillan Robert R.,
Podder Hemangshu,
Nolte Fong Joy V.,
Jones Stephen L.,
Yi Stephanie G.,
Elshawwaf Mahmoud,
Gaber Ahmed O.,
Ghobrial Rafik M.
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14304
Subject(s) - medicine , propensity score matching , liver transplantation , cohort , surgery , transplantation , proportional hazards model , survival analysis , cirrhosis , kidney transplantation , cohort study
Background Careful donor‐recipient matching and reduced ischemia times have improved outcomes following donation after circulatory death (DCD) liver transplantation (LT). This study examines a single‐center experience with DCD LT including high‐acuity and hospitalized recipients. Methods DCD LT outcomes were compared to a propensity score–matched (PSM) donation after brain death (DBD) LT cohort (1:4); 32 DCD LT patients and 128 PSM DBD LT patients transplanted from 2008 to 2018 were included. Analyses included Kaplan‐Meier estimates and Cox proportional hazards models examining patient and graft survival. Results Median MELD score in the DCD LT cohort was 22, with median MELD of 27 for DCD LT recipients with decompensated cirrhosis. No difference in mortality or graft loss was found ( p < .05) between DCD LT and PSM DBD LT at 3 years post‐transplant, nor was DCD an independent risk factor for patient or graft survival. Post‐LT severe acute kidney injury was similar in both groups. Ischemic‐type biliary lesions (ITBL) occurred in 6.3% ( n = 2) of DCD LT recipients, resulting in 1 graft loss and 1 death. Conclusion This study supports that DCD LT outcomes can be similar to DBD LT, with a low rate of ITBL, in a cohort including high‐acuity recipients. Strict donor selection criteria, ischemia time minimization, and avoiding futile donor/recipient combinations are essential considerations.