Within the last decade, liver transplantation from donation after circulatory death (DCD) donors has gained interest and outcomes have improved. This is mainly due to an increased awareness of the unique risks associated with this type of donation, subsequent selection policies aimed at mitigating these risks, and use of machine perfusion. Although outcomes have evolved over the past two decades to be comparable to grafts recovered from donation after brain death (DBD) donors and national and institutional policies have steadily expanded criteria for donor graft acceptance, the overall utilization rate of DCD livers remains suboptimal. The relatively high incidence of biliary complications in DCD liver grafts remains a concern as DCD organ utilization expands, but even these complications have been significantly reduced with the adoption of various machine perfusion strategies. In this chapter, we describe the current state of outcomes reported after liver transplantation from controlled and uncontrolled DCD donors with a specific focus on graft and patient survival, liver function and biliary complications, vascular complications, renal impairment, and rejection. We conclude with a discussion of how transplant clinicians, surgeons, and scientists can coordinate efforts in reporting outcomes and identifying standards for evaluating performance with DCD liver transplants. Finally, suggestions on how to assess and report outcomes in a more standardized and transparent way are provided to further improve outcomes in recipients of DCD liver grafts.

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DCD Liver Transplant Outcomes Over Time

  • John Sincavage,
  • Raphaël M. J. Fischer,
  • Peter L. Abt

摘要

Within the last decade, liver transplantation from donation after circulatory death (DCD) donors has gained interest and outcomes have improved. This is mainly due to an increased awareness of the unique risks associated with this type of donation, subsequent selection policies aimed at mitigating these risks, and use of machine perfusion. Although outcomes have evolved over the past two decades to be comparable to grafts recovered from donation after brain death (DBD) donors and national and institutional policies have steadily expanded criteria for donor graft acceptance, the overall utilization rate of DCD livers remains suboptimal. The relatively high incidence of biliary complications in DCD liver grafts remains a concern as DCD organ utilization expands, but even these complications have been significantly reduced with the adoption of various machine perfusion strategies. In this chapter, we describe the current state of outcomes reported after liver transplantation from controlled and uncontrolled DCD donors with a specific focus on graft and patient survival, liver function and biliary complications, vascular complications, renal impairment, and rejection. We conclude with a discussion of how transplant clinicians, surgeons, and scientists can coordinate efforts in reporting outcomes and identifying standards for evaluating performance with DCD liver transplants. Finally, suggestions on how to assess and report outcomes in a more standardized and transparent way are provided to further improve outcomes in recipients of DCD liver grafts.