Progression of Liver Transplant Outcomes From Donors After Circulatory Death in the United States: A 23-Year Comparative Analysis With Donors After Brain Death.

OBJECTIVES

We evaluated outcomes of liver transplant from donors after cardiac death versus transplants from donors after brain death, assessing trends over time.

MATERIALS AND

METHODS

Using the Scientific Registry of Transplant Recipients, we retrospectively analyzed liver transplants in the United States from January 2000 through May 2023. We categorized patients by donor type and transplant period.

RESULTS

After inclusion and exclusion criteria were considered, 99 014 patients were evaluated (32 498 patients in the 2000 -2010 group and 66 516 patients in the 2011 -2023 group ). From the first to the second time period, liver transplants from donors after cardiac death increased from 4 -% to 8.5 -%. For both time periods, liver transplant recipients from donors after cardiac death had lower Model for End-Stage Liver Disease scores than recipients from donors after brain death (18.61 ± 8.39 vs 20.32 ± 8.91 in 2000-2010 {P < .001 } and 17.31 ± 7.24 vs 22.49 ± 10.45 in 2011-2023 {P < .001 } ). Compared with transplants with donors after cardiac death, transplants with donors after brain death had higher 5 -year graft survival (72.36 % vs 68.56 % in 2000-2010 {P < .001 }; 80.22 % vs 78.06 % in 2011 -2023 {P = .021 } ) and patient survival rates (72.09 % vs 68.56 % in 2000 -2010 {P < .001 }; 79.65 % vs 77.32 % in 2011 -2023 {P = .016 } ). Of note, the survival difference decreased in the second time period. Regarding graft failure, more transplant recipients from donors after cardiac death (vs donors after brain death ) had biliary tract complications (9.7 % vs 4.9 %; P < .001 ).

CONCLUSIONS

Outcomes of liver transplants from donations after cardiac death have significantly improved, potentially partly as a result of allocation of donation after cardiac death livers to patients with lower Model for End -Stage Liver Disease scores in recent years.