Improved Waitlist Outcomes in Liver Transplant Patients With Mid-MELD-Na Scores Listed in Centers Receptive to Use of Organs Donated After Circulatory Death

Abstract

Background. Liver transplant (LT) using organs donated after circulatory death (DCD) has been increasing in the United States. We investigated whether transplant centers’ receptiveness to use of DCD organs impacted patient outcomes. Methods. Transplant centers were classified as very receptive (group 1), receptive (2), or less receptive (3) based on the DCD acceptance rate and DCD transplant percentage. Using organ procurement and transplantation network/UNOS registry data for 20 435 patients listed for LT from January 2020 to June 2022, we compared rates of 1-y transplant probability and waitlist mortality between groups, broken down by model for end-stage liver disease-sodium (MELD-Na) categories. Results. In adjusted analyses, patients in group 1 centers with MELD-Na scores 6 to 29 were significantly more likely to undergo transplant than those in group 3 (aHR range 1.51–2.11, P < 0.001). Results were similar in comparisons between groups 1 and 2 (aHR range 1.41–1.81, P < 0.001) and between groups 2 and 3 with MELD-Na 15–24 (aHR 1.19–1.20, P < 0.007). Likewise, patients with MELD-Na score 20 to 29 in group 1 centers had lower waitlist mortality than those in group 3 (scores, 20–24: aHR, 0.71, P = 0.03; score, 25–29: aHR, 0.51, P < 0.001); those in group 1 also had lower waitlist mortality compared with group 2 (scores 20–24: aHR0.69, P = 0.02; scores 25–29: aHR 0.63, P = 0.03). One-year posttransplant survival of DCD LT patients did not vary significantly compared with donation after brain dead. Conclusions. We conclude that transplant centers’ use of DCD livers can improve waitlist outcomes, particularly among mid-MELD-Na patients.