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Modern-Day Practice of DCD Liver Transplantation: Controversies, Innovations, and Future Directions

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Abstract

Purpose of Review

Over the past decade, donation after circulatory death (DCD) liver transplantation has expanded in the United States due to improved surgical experience and perioperative management. Despite these advances, there remains a reluctance towards broader utilization of DCD liver allografts due to lack of standardized donation process, concern for inferior graft survival, and risk of ischemic cholangiopathy associated with temporary lack of oxygenated perfusion during withdrawal of life-supporting treatment during procurement.

Recent Findings

New perfusion technologies offer potential therapeutic options to mitigate biliary complications and expand utilization of marginal DCD grafts. As these modalities enter routine clinical practice, DCD utilization will continue to increase, and liver allocation policies in turn will evolve to reflect this growing practice.

Summary

This review describes recent progress in DCD LT, current challenges with utilization of DCD liver allografts, and how novel technologies and policies could impact the future of the field.

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Abbreviations

CIT:

Cold ischemia time

DBD:

Donation after brain death

DCD:

Donation after circulatory death

ERCP:

Endoscopic retrograde cholangiopancreatography

EVMP:

Ex vivo machine perfusion

HOPE:

Hypothermic oxygenated machine perfusion

ITBS:

Ischemic type biliary strictures

IC:

Ischemic cholangiopathy

LT:

Liver transplantation

MMaT:

Median MELD at transplant

NRP:

Normothermic regional perfusion

NMP:

Normothermic machine perfusion

PTC:

Percutaneous transhepatic cholangiogram

SCS:

Static cold storage

Tpa:

Tissue plasminogen activator

fWIT:

Functional warm ischemia time

WIT:

Warm ischemia time

WLST:

Withdrawal of life supporting treatment

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Authors and Affiliations

  1. Department of Surgery, Beth Israel Deaconess Medical Center, Lowry Building 7th Floor, 110 Francis St, Boston, MA, 02215, USA

    Omar J. Haque, Eve M. Roth & David D. Lee

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  1. Omar J. Haque
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  2. Eve M. Roth
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All authors contributed equally to the review of the literature, writing of the manuscript and final review and approval of the manuscript.

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Correspondence to David D. Lee.

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Haque, O.J., Roth, E.M. & Lee, D.D. Modern-Day Practice of DCD Liver Transplantation: Controversies, Innovations, and Future Directions. Curr Gastroenterol Rep 25, 413–420 (2023). https://doi.org/10.1007/s11894-023-00902-8

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