The critical shortage of deceased organ donors has led to increased utilization of DCD liver grafts. The purpose of this study was to evaluate DCD allografts in orthotopic liver transplant outcomes (hypoxic cholangiopathy(HC), long-term patient/graft survival), and assess donor risk conditions. From 2003-2013, 45 DCD donor transplants were performed. Donor Ischemia Time was defined as the number of minutes from the onset of diastolic blood pressure<60 torr until aortic cross clamping. Donor Hypoxemia Time was defined as the number of minutes from the onset of SpO2<80% until aortic cross clamping. Donor Hypoxia Score was defined as (Donor Ischemia Time + Donor Hypoxemia Time) ÷ donor preoperative hemoglobin(Hb). The one, three, and five year graft and patient survival rates were: 83%, 77%, 60%, and 92%, 84%, and 72%, respectively. Overall, HC occurred in 48.9% of recipients. Univariate analysis: HC occurred with increased age (33.0±10.6, p=0.0149), lower donor pre-operative Hb (10.7 ± 2.2, p= 0.0172), higher Donor Hypoxia Score (2.7 ± 0.9, p=0.0342), and a Donor Hypoxia Score >2.0 (69.6%, p=0.0062, RR=2.8). Multivariate analysis showed that recipient HC was independently associated with increased age (p=0.1012), lower preoperative MAP (p=0.0560), lower preoperative arterial O2 content (p=0.0755), lack of preoperative RBC or multiple-pressor administration (p=0.0278), and greater Donor Hypoxia Score >2.0 (p=0.0589) (r2 = 0.6197). However, HC was not associated (p>0.05) with extubation-to-cross clamp, extubation-to-asystole, or asystole-to-cross clamp. Several easily measured indices at the time of donation can produce a Donor Hypoxia Score to predict hypoxic cholangiopathy post-transplant.

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