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Review
. 2020;7(3):194-204.
doi: 10.1007/s40472-020-00283-1. Epub 2020 Jul 13.

The Changing Landscapes in DCD Liver Transplantation

Kristopher P Croome  1 , C Burcin Taner  1
Affiliations
Review

The Changing Landscapes in DCD Liver Transplantation

Kristopher P Croome et al. Curr Transplant Rep. 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: Allocation; DCD; Ischemic cholangiopathy; Non-heart beating.

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Conflict of interest statement

Conflict of InterestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Number of DCD liver transplants performed in the USA 1993–2018
Fig. 2
Fig. 2
Graft survival following DCD LT divided by era [5]. Kaplan-Meier graft survival estimates by era of DCD LT. Era 1 versus era 2 (P = 0.001), era 2 versus era 3 (P < 0.001), and era 1 versus era 3 (P < 0.001)
Fig. 3
Fig. 3
New acuity circle organ distribution for DCD donors [12]
Fig. 4
Fig. 4
The UK DCD-Risk Index [35]
Fig. 5
Fig. 5
Dial of ischemic cholangiopathy risk with increasingly riskier DCD liver transplant variables
See this image and copyright information in PMC

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