Living donors (LD) and donation after-circulatory-death (DCD) grafts represent important opportunities to increase the donor pool. We reviewed the combined experience at Toronto General Hospital and Ochsner Medical Center from January 2009 to August 2013 comparing DCD (N=85) and LD (N=169) liver transplantation. All DCD recipients received intra-arterial tPA at surgery. The mean follow-up was 34.2±17 months. The median recipient MELD score at time of transplant was 16 (6-40) for LD and 20 (6-40) for DCD (p=0.004). There was no difference in the median length of hospital stay [DCD: 9 (4-118); LD: 10 (4-161), p=0.7]. The 30-day post-transplant mortality was 1.1% in the DCD group vs. 3.6% in the LD group, p=0.4. There was no difference in the overall rate of biliary strictures (16.4% DCD group vs. 11.2% LD group, p=0.24). All anastomotic strictures in the DCD group (N=12, 14.1%) were repaired endoscopically. Only 2 grafts developed diffuse ischemic-type strictures with 1 progressing to graft failure. All strictures in the LD group were anastomotic (N=16); 11 were corrected endoscopically/interventional radiology, 4 required surgical revision and 1 progressed to graft failure. The re-transplantation rate was 4.3% DCD group vs. 4.1% LD group , p=0.9. The 1-, 3- and 5- year graft survival was 91%, 88% and 88% for DCD compared to 92%, 83% and 82% for LD, p=0.45. The 1-, 3- and 5- year patient survival was 94%, 91% and 91% for DCD compared to 93%, 86% and 86% for LD, p=0.37. Our combined experience demonstrates similarly excellent outcomes for DCD and LD liver transplantation.

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