Liver transplantation using grafts from donors after circulatory death: A propensity-matched study from a single centre

The use of livers from donors following circulatory death (DCD) is increasing, but concerns regarding outcomes following use of marginal donors exist. To compare outcomes in transplants using DCD and DBD (donation following brain death), a propensity match was performed on 973 patients with chronic liver disease and/or malignancy who underwent primary whole liver transplant between 2004 and 2014 at University Hospital Birmingham. Primary endpoints were overall graft and patient survival. Secondary endpoints included post-operative, biliary and vascular complications. Over 10 years, 234 transplants were carried out using DCD grafts. Of the 187 matched DCD's, 82.9% were classified as "marginal" as per British Transplant Society Guidelines. Kaplan-Meier analysis of graft and patient survival found no significant differences for either outcome between the paired DCD and DBD patients (p=0.162 and 0.519 respectively). AST was significantly higher in DCD recipients until 48 hours posttransplant (p<0.001). The incidences of acute kidney injury and ischemic cholangiopathy were greater in DCD recipients (32.6% vs. 15% [p<0.001] and 9.1% vs. 1.1% [p<0.001] respectively). With appropriate recipient selection, the use of DCD's, including those deemed marginal, can be used safely and produce outcomes comparable to those seen when using DBD grafts in similar recipients. This article is protected by copyright. All rights reserved.