Liver transplantation benefits registrants with MELD≥18. However, this benefit no doubt varies by donor characteristics, and the benefit of DCD livers remains unclear.

Methods: We used Cox regression and SRTR data 2006-2015 to estimate mortality associated with DCD-LT among registrants without status-1/exception, adjusting for patient characteristics. We further calculated survival benefit of DCD-LT stratified by Donor Risk Index (DRI). Effect modification analysis identified MELD subgroups who benefit from DCD-LT. Additionally, we studied discard associated with DCD, using Poisson regression.

Results: Among 25,383 recipients, 1,269 (5%) received DCD-LT. DCD-LT conferred significantly lower mortality after 1m post-LT among low/medium-DRI livers, but not among high-DRI livers (Table1):

Consequently, cumulative 5-year mortality was ₃₇51₆₁% lower for DCD recipients with low DRI, ₃₄47₅₈% lower for DCD recipients with medium DRI, and unchanged (_-157₂₆%) for DCD recipients with high DRI:

DCD benefit varied by MELD. (e.g. high DRI):

DCD-LT with low/medium/high DRI provided significant 5-years survival benefit for registrants with MELD≥18/21/25, respectively.

DCD had 2-3-fold higher discard risk than DBD with similar DRI (Table2):

Conclusions: DCD-LT provides long-term survival benefit, especially for registrants with MELD≥25. Lower DRI conferred greater benefit. Discard rates for DCD livers are very high, but some discarded DCD livers may provide significant survival benefit for some patients.

CITATION INFORMATION: Luo X, Massie A, Segev D. Survival Benefit of DCD Livers. Am J Transplant. 2016;16 (suppl 3).

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