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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.