Use of extended criteria donors (ECD) and donation after circulatory death (DCD) donors are strategies to address organ shortage in liver transplantation (LT). We studied the characteristics and outcomes of ECD and DCD grafts.
We retrospectively studied consecutive adults who underwent deceased-donor LT between 2006-2019. ECD was defined using modified Eurotransplant criteria. Our primary outcomes were graft and patient survival.
798 grafts were used for LT, of which 93.1% were donation after brain death (DBD; 59.9% were also ECD) and 6.9% were DCD grafts (49.1% were also ECD). Among DBD graft recipients, donors having > 33% liver steatosis or three ECD criteria resulted in poorer graft survival. Otherwise ECD grafts recipients had similar graft and patient survival compared to non-ECD graft recipients. DCD graft recipients also had similar patient survival compared to DBD recipients. However, DCD grafts from an ECD appeared to have worse outcomes. DCD graft recipients experienced higher rates of early allograft dysfunction (50.9% vs. 24.7%, P<0.001) and ischemic biliopathy (16.4% vs 1.7%, P<0.001) compared to DBD graft recipients.
Use of DBD grafts from ECDs did not impact on outcomes unless there was significant donor steatosis or three Eurotransplant criteria were met. DCD graft recipients have similar patient survival compared to DBD graft recipients as long as the donor was not ECD. We recommend that DBD donors with three or more ECD features or > 33% steatosis, and DCD donors with any ECD features be used with caution in adult LT.

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