Safety and Outcomes in 100 Consecutive Donation After Circulatory Death Liver Transplants Using a Protocol That Includes Thrombolytic Therapy

Donation after circulatory death (DCD) liver transplantation (LT) reportedly yields inferior survival and increased complication rates compared with donation after brain death (DBD). We compare 100 consecutive DCD LTusing a protocol that includes thrombolytic therapy (late DCDgroup) to an historical DCDgroup (early DCDgroup n = 38) and a cohort of DBD LTrecipients (DBDgroup n = 435). Late DCD LTrecipients had better 1‐ and 3‐year graft survival rates than early DCD LTrecipients (92% vs. 76.3%, p = 0.03 and 91.4% vs. 73.7%, p = 0.01). Late DCDgraft survival rates were comparable to those of the DBDgroup (92% vs. 93.3%, p = 0.24 and 91.4% vs. 88.2%, p = 0.62). Re‐transplantation occurred in 18.4% versus 1% for the early and late DCDgroups, respectively (p = 0.001). Patient survival was similar in all three groups. Ischemic‐type biliary lesions (ITBL) occurred in 5%, 3%, and 0.2% for early DCD, late DCD, and DBDgroups, respectively, but unlike in the early DCDgroup, in the late DCDgroup ITBLwas endoscopically managed and resolved in each case. Using a protocol that includes a thrombolytic therapy, DCD LTyielded patient and graft survival rates comparable to DBD LT. Optimization of perioperative conditions and the inclusion of a novel protocol that includes thrombolytic therapy improve outcomes in donation after circulatory death liver transplantation.