Advantages and Limitations of Clinical Scores for Donation After Circulatory Death Liver Transplantation

Raphael P H Meier; Yvonne Kelly; Seiji Yamaguchi; Hillary J Braun; Tyler Lunow-Luke; Dieter Adelmann; Claus Niemann; Daniel G Maluf; Zachary C Dietch; Peter G Stock; Sang-Mo Kang; Sandy Feng; Andrew M Posselt; James M Gardner; Shareef M Syed; Ryutaro Hirose; Chris E Freise; Nancy L Ascher; John P Roberts; Garrett R Roll

doi:10.3389/fsurg.2021.808733

Advantages and Limitations of Clinical Scores for Donation After Circulatory Death Liver Transplantation

Front Surg. 2022 Jan 5:8:808733. doi: 10.3389/fsurg.2021.808733. eCollection 2021.

Authors

Raphael P H Meier^{1

2}, Yvonne Kelly¹, Seiji Yamaguchi¹, Hillary J Braun¹, Tyler Lunow-Luke¹, Dieter Adelmann^{1

3}, Claus Niemann^{1

3}, Daniel G Maluf², Zachary C Dietch¹, Peter G Stock¹, Sang-Mo Kang¹, Sandy Feng¹, Andrew M Posselt¹, James M Gardner¹, Shareef M Syed¹, Ryutaro Hirose¹, Chris E Freise¹, Nancy L Ascher¹, John P Roberts¹, Garrett R Roll¹

Affiliations

¹ Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.
² Department of Surgery, University of Maryland, Baltimore, MD, United States.
³ Department of Anesthesia, University of California, San Francisco, San Francisco, CA, United States.

Abstract

Background: Scoring systems have been proposed to select donation after circulatory death (DCD) donors and recipients for liver transplantation (LT). We hypothesized that complex scoring systems derived in large datasets might not predict outcomes locally. Methods: Based on 1-year DCD-LT graft survival predictors in multivariate logistic regression models, we designed, validated, and compared a simple index using the University of California, San Francisco (UCSF) cohort (n = 136) and a universal-comprehensive (UC)-DCD score using the United Network for Organ Sharing (UNOS) cohort (n = 5,792) to previously published DCD scoring systems. Results: The total warm ischemia time (WIT)-index included donor WIT (dWIT) and hepatectomy time (dHep). The UC-DCD score included dWIT, dHep, recipient on mechanical ventilation, transjugular-intrahepatic-portosystemic-shunt, cause of liver disease, model for end-stage liver disease, body mass index, donor/recipient age, and cold ischemia time. In the UNOS cohort, the UC-score outperformed all previously published scores in predicting DCD-LT graft survival (AUC: 0.635 vs. ≤0.562). In the UCSF cohort, the total WIT index successfully stratified survival and biliary complications, whereas other scores did not. Conclusion: DCD risk scores generated in large cohorts provide general guidance for safe recipient/donor selection, but they must be tailored based on non-/partially-modifiable local circumstances to expand DCD utilization.

Keywords: biliary complications; donation after circulatory death; hepatectomy time; ischemic cholangiopathy; liver transplantation; score; warm ischemia time.