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Donation after Circulatory Death (DCD) Liver Transplantation pp 87–112Cite as

Donor Selection in DCD Liver Transplantation

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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.

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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

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Authors and Affiliations

  1. Institute of Liver Studies, King’s College Hospital, London, UK

    Miriam Cortes-Cerisuelo

  2. Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, UK

    Andrea Schlegel

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  1. Miriam Cortes-Cerisuelo
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  2. Andrea Schlegel
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Correspondence to Andrea Schlegel .

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Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, FL, USA

    Kristopher P. Croome

  2. Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Paolo Muiesan

  3. Department of Transplant, Mayo Clinic, Jacksonville, FL, USA

    C. Burcin Taner

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Cortes-Cerisuelo, M., Schlegel, A. (2020). Donor Selection in DCD Liver Transplantation. In: Croome, K., Muiesan, P., Taner, C. (eds) Donation after Circulatory Death (DCD) Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-030-46470-7_7

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