AbbreviationsCITcold ischemia timeDBDdonation after brain deathDCDdonation after circulatory deathDWITdonor warm ischemia timeLTliver transplantationMELDModel for End‐Stage Liver DiseaseDespite improved donation after circulatory death (DCD) liver transplantation (LT) outcomes in the United States over the last 15 years, they represent only 6% of the total. There are multiple factors that contribute to this low number. These include the following:Inferior graft survival compared with donation after brain death (DBD) donors.Increased incidence of posttransplant cholangiopathy resulting in significant morbidity and need for retransplantation.However, judicious selection of DCD grafts results in outcomes comparable with DBD grafts.Factors potentially impacting DCD outcomes include donor age, donor body mass index, recipient age, Model for End‐Stage Liver Disease (MELD) score, donor warm ischemia time (DWIT), functional DWIT, cold ischemia time (CIT), and retransplantation. Shorter ischemia times, lower recipient MELD scores, and younger recipient age positively impact DCD outcomes. The use of allografts from DCD donors <50 years with short CIT resulted in better outcomes compared with that seen with DBD donor livers with age ≥60 years in 1 report. Although most agree that the use of younger DCD donor livers are more likely to yield more favorable outcomes, the upper donor age limit for DCD liver acceptance remains
Liver Transplantation – Wiley
Published: Jan 1, 2018
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