The article reviews the current state of liver transplantation using allografts from donation after cardiac death (DCD), focusing on single and multicenter outcomes, best practice guidelines and emerging strategies to optimize utilization of this precious resource.
DCD is being embraced as one effective way to solve the organ shortage and is contributing the largest increase to the pool of liver allografts. However, ischemic cholangiopathy and substandard graft survival remain significant risks for recipients of DCD livers. Risk factors for poor outcome after DCD liver transplant (LTX) are being identified, including older donor age and longer ischemia times. Emerging practice guidelines for DCD LTX focus on donor criteria, consent, withdrawal of support, operative technique, ischemia times, recipient considerations, and biliary issues. Research is under way to further identify risk factors for DCD LTX and strategies to protect against ischemic injury, and there are efforts to standardize procurement protocols, refine data reporting and facilitate multicenter research collaboration.
Livers from DCD remain a partially tapped resource for patients who require transplantation. Although some centers have successful experiences with DCD LTX, there are challenges unique to this endeavor. Donor and recipient selection criteria, perioperative factors and surgical technique are each critical aspects of DCD LTX. It is important to continue to develop this field so that more DCD LTX can be safely performed.
aDivision of Multiorgan Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
bDumont-UCLA Liver Cancer and Transplant Centers, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
Correspondence to David J. Reich, MD, FACS, Professor and Chief, Division of Multiorgan Transplantation and Hepatobiliary Surgery, Drexel University College of Medicine, Hahnemann University Hospital, 216 North Broad Street, 5th Floor, Feinstein Building, MS 1001, Philadelphia, PA 19102, USA Tel: +1 215 762 7143; fax: +1 215 762 3846; e-mail: firstname.lastname@example.org