The Implication of Center Volumes in Donation After Circulatory Death for Liver Transplantation: Donor–Recipient Selection and Outcomes

The use of donation after circulatory death liver transplant (DCD LT) has increased and the outcomes have improved. There are little data concerning the details of centers’ practice. Using the United Network for Organ Sharing Standard Transplant Analysis and Research data, the centers were stratified into 4 quartiles: lowest-, low-, high-, and highest-volume quartiles. High-risk donors, defined as older donors (≥50 years) or obese donors (body mass index ≥ 30 kg/m2), linearly increased in line with the centers’ volumes (P < .001), while cold ischemia time (CIT) showed an inverse correlation (P < .001). High-risk recipients, defined as those with high Model for End-stage Liver Disease score, re-LT, inpatient, or ventilator/dialysis before LT, did not show any significant difference (P = .74) except in the highest-volume quartile (P < .001). One-year graft survival showed a bimodal pattern across the 4 quartiles (P = .027): superior graft survival in the highest-volume quartile and in the low-volume quartile and inferior graft survival in the high-volume quartile and in the lowest-volume quartile. High-risk donors can achieve satisfactory outcomes by being matched with low-risk recipients and shortening CIT. However, high-risk recipients may not result in favorable outcomes with DCD LT even with centers’ experience and shorter CIT.