Introduction: Organs from DCD donors, particularly livers, have been shown to have outcomes that are inferior to those from donation after brain death (DBD) donors focusing on retransplantation and death only. We report the cumulative differences by including relisted but not yet retransplanted patients in liver allograft loss rates at one year following transplantation from DCD and DBD donors. Methods: Data from the OPTN/UNOS database over a 10-year period was analyzed as to the number of patients re-listed for liver transplantation within 1 year of transplant using both DCD and DBD donors. We also compared the one-year graft loss after liver transplantation, from DCD and DBD donors. We calculated the cumulative liver allograft loss rate as the number of patients re-listed for transplant within 1 year + {100-one-year graft survival} = cumulative liver allograft loss rate.Results: Between 2000 and 2010, the number of patients re-listed for transplant within one year of liver transplantation using a DCD organ ranged from 14% to 23.4%, (overall rate 15.7%). In contrast, the number of patients re-listed for transplant within one year following liver transplantation using a DBD organ ranged from 4.6% to 10.8%, with an overall rate of 7%.

The cumulative liver allograft loss rate at one year for patients undergoing liver transplantation using DCD donors was 42.2% (i.e., a 15.7% re-listing rate + 26.5% graft loss rate at one year) compared with 24.7% for patients transplanted using DBD donors (i.e., 7% re-listing rate + 17.4% graft loss rate at one year). Conclusion: We have shown that cumulative liver allograft loss rates are significantly higher than previously reported. Patients listed for re-transplantation with a failing liver allograft carry a significant burden of risk in terms of morbidity and mortality, which is not adequately captured in the current metrics being measured (namely, one year graft survival).

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