The Changing Landscapes in DCD Liver Transplantation
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LIVER TRANSPLANTATION (D MULLIGAN AND R BATRA, SECTION EDITORS)
The Changing Landscapes in DCD Liver Transplantation Kristopher P. Croome 1 & C. Burcin Taner 1
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review The transplant community continues to look for ways to help address the discordance between donor liver graft availability and patients on the liver transplant waiting list. Donation after circulatory death (DCD) donor livers represents one potential means to help address this discordance. The present review describes the changing landscape of DCD liver transplantation (LT). Recent Findings The number of DCD LTs performed annually within the USA has continued to grow on an annual basis. Importantly, national data has demonstrated that outcomes with DCD LT have been improving. This improvement has been driven by better understanding of how to successfully utilize these organs through better donor and recipient matching and careful evaluation of both hemodynamics during withdrawal of life support and the refinement of the procurement operation. Summary Despite these improvements in outcome, ischemic cholangiopathy (IC) continues to be the Achilles heel of DCD LT. Emerging technologies such as various forms of machine perfusion may allow for reduction of complications and better prognostication of the risk associated with DCD liver grafts. Keywords DCD . Non-heart beating . Ischemic cholangiopathy . Allocation
Abbreviations AKI Acute kidney injury CIT Cold ischemia time DCD Donation after circulatory death DBD Donation after brain death DRI Donor risk index DWIT Donor warm ischemia time EAD Early allograft dysfunction fDWIT Functional donor warm ischemia time HCC Hepatocellular carcinoma HMP Hypothermic machine perfusion IC Ischemic cholangiopathy LT Liver transplant MELD Model for end-stage liver disease NMP Normothermic ex vivo perfusion NRP Normothermic regional perfusion PNF Primary non-function This article is part of the Topical Collection on Liver Transplantation * Kristopher P. Croome [email protected] 1
Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
PRS SCS SD
Post-reperfusion syndrome Static cold storage Standard deviation
Introduction The transplant community continues to look for ways to help address the discordance between donor liver graft availability and patients on the liver transplant waiting list. Donation after circulatory death (DCD) donor livers represents one potential means to help address this discordance. Initial reports examining the use of liver grafts from DCD described inferior longterm outcomes when compared with donation after brain death donors (DBD). These inferior results were ascribed to high rates of biliary complications, as well as increased rates of primary non-function and hepatic artery thrombosis [1–4]. Since those initial publications, there have been substantial developments in the understanding of how to effectively utilize DCD livers. More recent single center publications from high vol
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