Based on pre-transplant donor and recipient characteristics, cDCD liver recipients underwent propensity score matching (PSM) with recipients of liver-only transplantation from DBD donors in a 1:3 DCD:DBD ratio. We conducted a single center prospective observational cohort study including consecutive recipients of liver-only transplantation of controlled DCD (cDCD) donors from August 2020 to May 2022. Thus, this study aims to compare the outcomes of LTs involving elder DCD donors with both younger DCD donors and elder DBD donors in the specific context of an experienced Italian transplant center. Įven if donor age impacts the outcomes of LT, the acceptance of older DBD donor grafts could be effective in selected recipients. This phenomenon is most likely to affect the pool of DCD donors too, and data on LT from advanced-age DCD donors are emerging in the literature.
The constant increase in the average age of the general population also implies a subsequent change in the demography of the organ donor pool. Moreover, to further mitigate ischemia-reperfusion injury (IRI), most Italian transplant centers also implement end-ischemic hypothermic oxygenated perfusion (HOPE) on DCD liver grafts. A strategy of in-situ normothermic regional perfusion (NRP) -aimed to interrupt the prolonged ischemia and to maintain a near-physiologic environment during retrieval -is considered mandatory in the Italian scenario. Īccording to Italian law, death can only be declared after 20 min of lack of any cardiac electrical activity. Nevertheless, several recent studies have described acceptable results after transplantation involving those donors. DCD donors are a valuable source of grafts, even if concerns have been raised about potentially impaired outcomes related to prolonged warm ischemia time (WIT). The inclusion of extended criteria donors (ECDs) and donors after circulatory determination of death (DCD) is growing in the attempt to address the critical gap between donors and recipients. Liver transplantation (LT) is considered the treatment of choice for patients with end-stage liver disease. LT involving grafts retrieved from very elderly DCD donors was feasible and safe in an experienced high-volume center, with outcomes comparable to LTs from younger DCD donors and age-matched DBD donors. Short-term outcomes, as well as 12 months graft survival rates (93.3%, 100%, and 89.3% respectively), were comparable among the groups. After propensity score matching and stratification, three groups were obtained: 15 recipients of DCD donors ≥75 years, 11 recipients of DCD donors <75 years, and 28 recipients of DBD donors ≥75 years. One-hundred fifty-seven patients were included, 26 of whom (16.6%) were transplanted with a DCD liver graft. DCD recipients were propensity score matched 1:3 to DBD recipients. From August 2020 to May 2022, consecutive recipients of deceased donor liver-only transplants were enrolled in the study. We conducted a prospective cohort study to evaluate post-transplantation outcomes in recipients of grafts from elderly DCD donors compared with younger DCD donors, and elderly donors after brainstem determination of death (DBD). As the average age of populations rises, the donor pool is likely to be affected by a potential increase in DCD donor age in the near future. 6Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italyĭonation after circulatory determination of death (DCD) is a valuable strategy to increase the availability of grafts for liver transplantation (LT).5Department of Internal Medicine for the Treatment of Severe Organ Failure, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.4Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.3Ospedale “Maurizio Bufalini”-Azienda Unità Sanitaria Locale Romagna, Cesena, Italy.2Department of Transplant Intensive Care Unit, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.1Department of Hepatobiliary Surgery and Transplantation, Policlinico di Sant’Orsola, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Guido Fallani 1 †, Alberto Stocco 1 †, Antonio Siniscalchi 2, Marta Velia Antonini 3,4, Adriano Pasquale Stella 1, Alessio Amato 1, Enrico Prosperi 1, Laura Turco 5, Maria Cristina Morelli 5, Matteo Cescon 1,6 and Matteo Ravaioli 1,6*
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