CLINICAL OUTCOMES OF DCD TYPE V LIVER TRANSPLANTATION: DONATION AFTER EUTHANASIA

Introduction: Due to shortage of donor organs, physicians and surgeons are forced to accept livers from donation after circulatory death (DCD) donors. One special group of DCD organs are those obtained after euthanasia (DCD type V). To create more awareness on the possibility of organ donation after euthanasia, it is important to evaluate the results of transplantation with this type of graft. The aim of our study was to evaluate the outcome of DCD type V liver transplantation (LT) in the Netherlands and Belgium.
Methods: All DCD type V LT performed until 2018 in all three Dutch LT centers and four out of six Belgian LT centers, were included in this study. Grafts that have been preserved with machine perfusion were excluded. Continuous data are expressed as median (IQR), categorical data as number (percentage). Results: Until 2018, 44 DCD type V LT have been performed. Five cases in which the liver was preserved by machine perfusion were excluded. Median age of donor and recipient was 51 years (42–58) and 56 years (48–64), respectively. A neurological disease was the most common underlying disease in donors requesting euthanasia, followed by psychiatric disorders. Median time between administration of the euthanatics and cold perfusion was 19 min (14–25). Peak AST and ALT levels in the recipients were 904 U/l (586–2,478) and 709 U/l (448– 1,841) respectively. One-, three- and five-year patient survival was 90%, 83% and 83%, respectively (figure 1). Five patients (13%) required a retransplantation, due to PNF (n = 1), HAT (n = 1) or post-transplant cholangiopathy (n = 3), the majority within the first year after the prior LT.
Conclusion: Liver transplantations with grafts from donors who underwent euthanasia yield satisfying results during the relatively short follow up period that is currently available. Comparison of these results with DCD type III LT and donation after brain death (DBD) LT is currently ongoing.