Background: Scientific Studies Committee of ASTS conducted study to identify barriers to use of DCD liver grafts.

Objectives: Identify barriers to use of DCD liver allografts; compare center attitudes to UNOS data.

Methods:

Sent 40-question survey to LT centers; analyzed UNOS data for DCD (n=1357) and standard criteria donor (SCD) (n=25562) organs from 1/1/09 – 6/30/14 to identify prognostic factors unique to DCD organs; UNOS data compared to survey responses.

Results:

75% of 76 responding centers currently use DCD livers; 25% never or stopped using them. 65 centers that use/used DCD livers responded:

62 limit warm ischemia time 30 minutes; 3 accept >30 minutes

51 limit cold ischemia time (CIT) <8 hours; 14 accept ≥8 hours or no limit (NL)

56 accept donors <50 yrs of age; 9 accept ≥50 or NL

39 have no max recipient MELD

Estimates of IC: 0% (n=9), 1-5% (n=8), 6-10% (n=10), 11-20% (n=17), 21-30% (n=9), ≥50% (n=5), 7 no response.

46 centers requested MELD exception for IC; 29/46 reported granted, 5/46 reported denials; 6/46 don't know; 6/46 not applicable

19 centers reported deaths awaiting reLT; 8/19 reported deaths in patients with denied exception

52/72 centers feel current system is inadequate for timely reLT; 53/72 feel absence of a rescue pathway for patients with IC is a barrier for use of DCD organs.

UNOS data 1 & 3 yr patient survival (PS): 90%/80% for SCD; 86%/76% for DCD recipients (p<0.001). 1&3 yr graft survival (GS) 88%/78% for SCD; 82%/71% for DCD recipients (p<0.001). 88 of DCD group had reLT during the 5 year period. 67% of reLT cited biliary causes and/or PNF as primary or contributing factor.

MELD was significantly associated with PS and GS and CIT with GS for both DCD and SCD groups. The association between MELD and PS, MELD and GS and CIT and GS was stronger in the DCD group (p=0.045, p=0.009 and p=0.054).

Conclusion: MELD and CIT are assocated with PS and GS respectively despite selection variations. While 3 year graft survival is 7% lower for DCD group and most reLT are related to graft issues, the variability in reported rates of IC requires exploration. Lack of rescue pathway for patients with IC deters use of DCD livers. It is essential to develop uniform criteria and strategies and a MELD exception.

*Supported by One Legacy Foundation grant.

CITATION INFORMATION: Sher L, Abt P, Genyk Y, Lo M, Yan P, Ji L, Marsh C. Liver Transplantation (LT) Using Liver Allografts from Deceased After Cardiac Death (DCD) Donors: Opinions, Practices and Reality. Am J Transplant. 2016;16 (suppl 3).

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