Embracing Liver Transplantation From Donation After Circulatory Death in the United States in the Era of Perfusion Technology.

Abstract

Background: Utilization rates of potential deceased donors for liver transplantation has declined following the implementation of the acuity circles system in 2020. Since then, ex situ machine perfusion (es-MP) and normothermic regional perfusion (NRP) have been introduced in the United States.

Methods: Liver graft utilization rates were analyzed using the US national registry data from 2022 to 2024. The associations of es-MP and NRP practices with donation after circulatory death (DCD) utilization rates among organ procurement organizations (OPOs) and transplant center volume were evaluated.

Results: DCD donor utilization significantly increased from 21.5% in 2022 to 42.5% in 2024 (P < 0.001). Utilization of extended criteria donors (ECDs), including DCD donors aged ≥60 y or with a body mass index ≥40 kg/m2, also rose substantially, from 7.1% in 2022 to 33.2% in 2024 (P < 0.001). At the transplant center level, a significant correlation was found between the increase in transplant volume and both the es-MP use (r = 0.29; P = 0.01) and ECD utilization (r = 0.26; P = 0.02). At the OPO level, a significant association was observed between the increase in DCD utilization rate and NRP use (r = 0.29; P = 0.03).

Conclusions: DCD liver utilization has significantly increased, with a notable rise in the utilization of ECDs, which may be driven by new technologies such as es-MP and NRP. While es-MP at the center level use may increase transplant volume, NRP use at the OPO level appears to significantly improve DCD liver utilization.