Transplant Candidate Outcomes After Declining a DCD Liver in the United States

Author:

Ishaque Tanveen1,Eagleson Mackenzie A.2,Bowring Mary G.2,Motter Jennifer D.1,Yu Sile2,Luo Xun3,Kernodle Amber B.2,Gentry Sommer145,Garonzik-Wang Jacqueline M.6,King Elizabeth A.2,Segev Dorry L.145,Massie Allan B.14

Affiliation:

1. New York University Langone Transplant Institute, New York, NY.

2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

3. Department of Surgery, University Hospitals/Case Western Reserve University, Cleveland, OH.

4. Department of Surgery, New York University Grossman School of Medicine, New York, NY.

5. Scientific Registry of Transplant Recipients, Minneapolis, MN.

6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Abstract

Background. In the context of the organ shortage, donation after circulatory death (DCD) provides an opportunity to expand the donor pool. Although deceased-donor liver transplantation from DCD donors has expanded, DCD livers continue to be discarded at elevated rates; the use of DCD livers from older donors, or donors with comorbidities, is controversial. Methods. Using US registry data from 2009 to 2020, we identified 1564 candidates on whose behalf a DCD liver offer was accepted (“acceptors”) and 16 981 candidates on whose behalf the same DCD offers were declined (“decliners”). We characterized outcomes of decliners using a competing risk framework and estimated the survival benefit (adjusted hazard ratio [95% confidence interval]) of accepting DCD livers using Cox regression. Results. Within 10 y of DCD offer decline, 50.9% of candidates died or were removed from the waitlist before transplantation with any type of allograft. DCD acceptors had lower mortality compared with decliners at 10 y postoffer (35.4% versus 48.9%, P < 0.001). After adjustment for candidate covariates, DCD offer acceptance was associated with a 46% reduction in mortality (0.54 [0.49–0.61]). Acceptors of older (age ≥50), obese (body mass index ≥30), hypertensive, nonlocal, diabetic, and increased risk DCD livers had 44% (0.56 [0.42–0.73]), 40% (0.60 [0.49–0.74]), 48% (0.52 [0.41–0.66]), 46% (0.54 [0.45–0.65]), 32% (0.68 [0.43–1.05]), and 45% (0.55 [0.42–0.72]) lower mortality risk compared with DCD decliners, respectively. Conclusions. DCD offer acceptance is associated with considerable long-term survival benefits for liver transplant candidates, even with older DCD donors or donors with comorbidities. Increased recovery and utilization of DCD livers should be encouraged.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation

Reference47 articles.

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3. Donations after circulatory death in liver transplant.;Eren;Exp Clin Transplant,2016

4. The effect of the opioid epidemic on donation after circulatory death transplantation outcomes.;Wanis;Transplantation,2019

5. Utilization of livers donated after circulatory death for transplantation - an international comparison.;Eden;J Hepatol,2023

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