*Purpose: Expansion of liver transplantation (LT) from donors after circulatory death (DCD) has been increasingly used to overcome the persistent organ shortage and long waiting list mortality. However, DCD livers are associated with increased risk of graft loss and irreversible ischemic cholangiopathy necessitating early re-transplant. We present the experience of the Miami Transplant Institute (MTI) in DCD-LT over more than 5 years.

*Methods: We studied the patients who received DCD-LT between 2/2013 and 11/2019 at MTI. We used tissue plasminogen activator (tPA) protocol in all recipients but one. Recipients and donors’ characteristics, graft and patient survival, biliary complications and re-transplant were analyzed.

*Results: 49 patients received primary DCD-LT alone (36/49) and with kidney transplantation (13/49). Males constituted 73% (36/49) and 61% (30/49) of recipients and donors (D/R), respectively. Median age at transplant was 60(16-74) and 35(5-57) year-old, in D/R, respectively. Mean D/R body mass index was 27(±5.5) and 26(±6.5)Kg/m2, respectively. Mean MELD score was 23.9(±4.4). The most common indications for LT were hepatocellular carcinoma and alcoholic cirrhosis. The most common race in both D/R was white. Warm ischemia time was 20.7(±6.5) minutes. One patient with pre-transplant primary biliary cirrhosis developed diffuse biliary strictures after 3.5 months and lost the graft. We did not use tPA protocol in this patient. Primary graft non-function occurred in one patient at postoperative day 1. Both patients were re-transplanted. 3 patients died (2=sepsis;1=acute hypoxic respiratory failure) at 3,6,14 months post-transplant. Actuarial estimates for patient and graft survival were 98%,91%&91% and 94%,88%&88% at 1,2&5 years, respectively.

*Conclusions: DCD-LT showed favorable patient and graft survival over more than 5 years. Moreover, we reported the use of tPA protocol in DCD-LT was not associated with an increased risk of biliary-related morbidities.

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