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. Corresponding Author: Amanda J Vinson, MD, 5082 Dickson Building, QEII Health Sciences Centre-VG site, 5820 University Avenue, Halifax, Nova Scotia, B3H 1V9, 902-473-2675, 902-473-2749. Email: Amanda.vinson@nshealth.ca Authorship Page Authorship: All authors participated in research design. AV and BK did the initial data analysis and KT and BK provided feedback and suggestions to make the analysis more robust. AV wrote the initial manuscript and BK, BGL and KT provided feedback and helped with constructing the figures. Disclosures: The authors declare no conflicts of interest. Funding: There was no funding for this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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