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The Use of Donation After Cardiac Death Organs for Simultaneous Liver-Kidney Transplant: To DCD or Not to DCD?

BACKGROUND
Due to challenges with organ scarcity, many centers performing simultaneous liver-kidney transplant are opting to accept donation after cardiac death (DCD) organs as a means of facilitating earlier transplant and reducing death rates on the waitlist. It has been suggested however, that DCD organs may have inferior graft and patient survival posttransplant compared with donation after neurologic death (DND) organs.


METHODS
We created a Markov model to compare the overall outcomes of accepting a DCD SLKT now versus waiting for a DND SLKT in patients waitlisted for SLKT, stratified by base MELD score (≤ 20, 21-30, >30).


RESULTS
Waiting for DND SLKT was the preferred treatment strategy for patients with a MELD score of ≤ 30 (incremental value of 0.54 and 0.36 QALYs for MELD ≤ 20 and MELD 21-30 with DND versus DCD SLKT, respectively). The option to accept a DCD SLKT became the preferred choice for those with a MELD score > 30 (incremental value of 0.31 QALYs for DCD versus DND SLKT). This finding was confirmed in a probabilistic sensitivity analysis and persisted when analyzing total life years obtained for accept DCD versus do not accept DCD.


CONCLUSIONS
There is a benefit to accepting DCD SLKT for patients with MELD > 30. Although not accepting DCD SLKT and waiting for DND SLKT is the preferred option for patients with MELD ≤ 30, the incremental value is small.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.