Background: Multiple single center and national database reports in the liver transplant literature have demonstrated that liver transplantation following donation after circulatory death (DCD) is associated with poorer outcomes when compared with liver transplantation after brain dead donation (DBD). We hypothesized that 1) carefully selected DCD livers recovered from younger donors have excellent outcomes, and that 2) this population of livers is underutilized.

Methods: We performed a retrospective study of the UNOS database to determine the graft survival for patients who received liver transplants from DBD donors > 60 years, DBD donors < 60 years, and DCD donors < 50 years of age. Kaplan-Meier, chi-square, and T-Test analyses were used where appropriate.

Results: Between 1/2002 and 12/2014, 52,271 liver transplants were performed in the United States. Of these, 41,181 (78.8%) underwent transplantation with livers from DBD donors less than age 60, 8,905 (17.0%) from DBD donors greater than or equal to age 60, and 2,195 livers (4.2%) from DCD donors < 50 years of age. There was no difference in graft survival for DCD livers < 50 years compared to recipients of DBD livers > age 60 (p=0.001). DCD livers < age 50 years < 6 hours of cold ischemic time had superior graft survival when compared with DBD livers > age 60 (p<0.001). We then determined how many potential liver transplants would be possible if these parameters were considered by surgeons accepting liver offers. In 2014 there were 133 discarded DCD livers; of these, 111 (83.4%) were < age 50. The most common reason for discarding a liver was warm ischemia time. Excluding livers discarded for biopsy findings (n=21), anatomic abnormalities (n=10), and non-transplantable recipients (n=8), 77 potentially transplantable livers were discarded.

Conclusions: Young DCD donor livers (age < 50) with short cold ischemic times yield recipient results that are better than seen with brain dead donor livers > 60 years old. Careful donor organ and patient selection can lead to excellent results, despite previous reports which suggest otherwise. Acceptance of these livers would lead to increases in organ transplantation, nationwide.

CITATION INFORMATION: Scalea J, Redfield R, Foley D. Some DCD Livers Function as Well as DBD Livers: The Implications of Discarding Usable Livers. Am J Transplant. 2016;16 (suppl 3).

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