Survival Advantage from Accepting a Circulatory Death Liver Transplant
1Department of Surgery, University of Cambridge, Cambridge, United Kingdom
2Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, United Kingdom
3Department of Medicine, University of Birmingham, Birmingham, United Kingdom.
Meeting: 2018 American Transplant Congress
Abstract number: A269
Keywords: Donation, Donors, Liver transplantation, non-heart-beating, Survival
Session Information
Session Name: Poster Session A: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background
As liver failure increases in the UK, so does demand for liver transplantation. In response, UK donation after circulatory death (DCD) activity has approximately tripled in the last decade. However, outcomes following DCD liver transplantation are poorer than for brain-stem death (DBD) liver transplants, raising a major quandary: is it better to accept a “poorer quality” DCD organ, or to wait longer for a more optimal DBD organ?
Methods
Five-year transplant survival following elective deceased donor liver transplantation performed between 2008 and 2015 was compared by Cox regression modelling of UK Transplant Registry data. The impact on patient survival of accepting a DCD liver compared to deferring for a potential DBD transplant was assessed by sequentially stratified Cox regression modelling.
Findings
Nine-hundred and three (23%) of the 3949 liver transplantations performed utilised DCD donors. Five-year transplant survival was poorer following DCD than DBD transplantation (adjusted hazard ratio [HR] = 1[middot]65, 1[middot]40 – 1[middot]94).
Of the 5798 patients registered on the transplant list, 1325 (23%) died or were removed from the list without receiving a transplant. Critically, patients who received DCD livers had a lower risk-adjusted hazard of death than those who remained on the waiting list for a potential DBD organ (adjusted HR 0[middot]55, 0[middot]47 – 0[middot]65), with the greatest survival benefit conferred for those with most advanced liver disease (adjusted HR 0[middot]19 (0[middot]07, 0[middot]50) for top tier patients (UKELD>63)).
Conclusion
Although DCD liver transplants are associated with poorer transplant outcomes, the individual's survival prospects are enhanced by accepting, rather than rejecting, a DCD offer, particularly for patients with more severe liver disease. DCD liver transplantation improves overall survival for UK listed patients and should be encouraged.
CITATION INFORMATION: Richards J., Taylor R., Allen E., Goh A., Neuberger J., Collett D., Pettigrew G. Survival Advantage from Accepting a Circulatory Death Liver Transplant Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Richards J, Taylor R, Allen E, Goh A, Neuberger J, Collett D, Pettigrew G. Survival Advantage from Accepting a Circulatory Death Liver Transplant [abstract]. https://atcmeetingabstracts.com/abstract/survival-advantage-from-accepting-a-circulatory-death-liver-transplant/. Accessed May 14, 2025.« Back to 2018 American Transplant Congress