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Donor Selection in DCD Liver Transplantation

  • Miriam Cortes-Cerisuelo
  • Andrea SchlegelEmail author
Chapter
  • 17 Downloads

Abstract

Despite recent outcome improvement, liver transplantation from donation after circulatory death (DCD) donors remains a challenge. Multiple donor, graft and procurement factors not only contribute to the results after transplantation but also impact on the selection process and the decision to utilize or decline such livers, which potentially transmit a high risk for severe complications including primary graft non-function or ischemic cholangiopathy. Although the transplant community has gained significant experience in this field, the majority of risk factors is still inconsistently reported with various acceptance criteria and thresholds, when to accept a DCD donor liver, which also depends on national and centre guidelines and the surgeons’ experience. Throughout the past 10 years, we have developed an increasing awareness of the cumulative risk and how to best combine donor and recipient parameters, which encouraged the community to adapt the allocation process and to match certain DCD livers with presumed higher risk with healthier recipients, as, for example, with candidates with liver tumours. In this chapter, we highlight currently considered donor and graft risk factors and how they contribute to outcomes after transplantation. Additionally, we also describe the impact of donor surgery and current prediction models which may influence the DCD liver selection process and how we may expect new developments and preservation technology to impact on our decisions in the future.

Keywords

DCD Donor risk factors Risk assessment Prediction models 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

BMI

Body max index

CIT

Cold ischemia time

CVA

cerebrovascular accident

DAA

Direct-acting antiviral medications

DBD

Donation after brain death

DCD

Donation after circulatory death

DCD-RI

DCD-risk index

DM

Diabetes mellitus

DRI

Donor risk index

ET-DRI

Eurotransplant Donor Risk Index

fDWIT

Functional donor warm ischemia time

GGT

Gammy-glutamyl-transferase

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

HMP

Hypothermic machine perfusion

HOPE

Hypothermic oxygenated perfusion

IC

Ischemic cholangiopathy

ITU

Intensive care unit

KCH

King’s College Hospital

MELD

Model of End Liver Disease

NHS

National Health Service

NHSBT

National Health Service Blood and Transplant

NMP

Normothermic machine perfusion

NRP

Normothermic regional perfusion

PNF

Primary non-function

UCLA

University of California at Los Angeles

UHB

University Hospitals Birmingham

UK

United Kingdom

UK-DCD-Risk Score

United Kingdom Donation after Circulatory Death Risk Score

UNOS

United Network of Organ Sharing

USA

United States of America

Notes

Disclosure

Authors have nothing to disclose.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Institute of Liver StudiesKing’s College HospitalLondonUK
  2. 2.Liver UnitQueen Elizabeth Hospital BirminghamBirminghamUK

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