Safety and Outcomes in 100 Consecutive Donation After Circulatory Death Liver Transplants Using a Protocol That Includes Thrombolytic Therapy

Am J Transplant. 2017 Aug;17(8):2155-2164. doi: 10.1111/ajt.14261. Epub 2017 Apr 11.


Donation after circulatory death (DCD) liver transplantation (LT) reportedly yields inferior survival and increased complication rates compared with donation after brain death (DBD). We compare 100 consecutive DCD LT using a protocol that includes thrombolytic therapy (late DCD group) to an historical DCD group (early DCD group n = 38) and a cohort of DBD LT recipients (DBD group n = 435). Late DCD LT recipients had better 1- and 3-year graft survival rates than early DCD LT recipients (92% vs. 76.3%, p = 0.03 and 91.4% vs. 73.7%, p = 0.01). Late DCD graft survival rates were comparable to those of the DBD group (92% vs. 93.3%, p = 0.24 and 91.4% vs. 88.2%, p = 0.62). Re-transplantation occurred in 18.4% versus 1% for the early and late DCD groups, respectively (p = 0.001). Patient survival was similar in all three groups. Ischemic-type biliary lesions (ITBL) occurred in 5%, 3%, and 0.2% for early DCD, late DCD, and DBD groups, respectively, but unlike in the early DCD group, in the late DCD group ITBL was endoscopically managed and resolved in each case. Using a protocol that includes a thrombolytic therapy, DCD LT yielded patient and graft survival rates comparable to DBD LT.

Keywords: clinical research/practice; donation after circulatory death (DCD); donors and donation; liver allograft function/dysfunction; liver transplantation/hepatology; organ procurement and allocation.

MeSH terms

  • Adult
  • Aged
  • Bile Duct Diseases / etiology*
  • Death
  • Donor Selection*
  • Female
  • Follow-Up Studies
  • Graft Rejection / etiology
  • Graft Survival
  • Humans
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Thrombolytic Therapy*
  • Tissue Donors*
  • Tissue and Organ Procurement / methods*
  • Vascular Diseases / etiology*
  • Young Adult