A single centre retrospective review of selection criteria for donation after circulatory death liver transplantation

Georgina E Riddiough¹, Michael A Fink^1,2, Graham Starkey¹, Bao Z Wang¹, Adam G Testro¹, Paul Gow¹, Rhys B Vaughan¹, Robert M Jones¹

¹Liver Transplant Unit, Austin Hospital, Melbourne, Australia, ²Department of Surgery, University of Melbourne, Melbourne, Australia

Introduction:  Ongoing demand for liver transplantation in addition to ongoing limited organ availability has led to increased use of organs from donation after circulatory death (DCD) donors.  Due to concerns over the success of such grafts related to prolonged warm ischaemia time careful selection of DCD grafts is imperative.

Methods:  We retrospectively assessed the number of DCD liver offers made between 1 October 2007 and 7 February 2013.  We reviewed our selection criteria for DCD liver grafts and examined reasons for declining such livers both immediately and at hepatectomy.  Data was extracted from our liver transplant database.

Results:  In total 86 DCD liver offers made to the Austin hospital in Victoria between 1 October 2007 and 7 February 2013.  52% (n = 45) of offers were declined immediately and 47% (n = 40) provisionally accepted, the remaining graft was exported to Queensland.  20% (n = 17) of grafts were transplanted; 9 grafts were declined at hepatectomy (reasons included hypoperfusion [n=2], hepatosteasosis [n=6]; one graft was declined when intraoperative findings indicated transplantation was no longer required). Reasons for immediately declining a DCD liver offer were varied, most commonly donor age >60 years (n=10).   In 25 cases a combination of factors such as alcohol consumption, obesity, diabetes mellitus, unknown viral status, down time and abnormal pathology results led to immediate graft rejection.

Conclusion:  One fifth of DCD liver grafts offered to the Austin were finally implanted.  In this group of DCD liver transplant recipients 1-year patient survival was 82% and 1-year graft survival was 71%.