A single-center comparison of liver grafts from donation after brain death and donation after circulatory death with normothermic regional perfusion

Donation after circulatory death (DCD) liver transplantation (LT) with normothermic regional perfusion (NRP) is superior to super rapid recovery (SRR) DCD LT with static cold storage (SCS). Early studies of SRR-SCS-DCD LT compared results to donation after brain death (DBD), but no studies have compared U.S. outcomes of DCD-NRP vs DBD LT. This study evaluated whether outcomes among DCD-NRP LT recipients are comparable to those of DBD recipients. We conducted a retrospective review of all DCD-NRP and DBD adult liver donors and recipients from January 1, 2021 through December 31, 2024 at our center. During the study period, 150 DBD and 79 DCD-NRP LTs were performed. Median donor age was higher in the DCD-NRP cohort (51 versus 41, p<0.001), and median MELD was lower in the DCD-NRP recipient cohort (18 vs. 23, p<0.001). There were no differences in patient and graft survival. Development of biliary anastomotic strictures at 12 months was similar. The 12-month competing-risk cumulative incidence of ischemic cholangiopathy in the DCD-NRP group was 4.5% (95% CI: 0.0%–9.6%). Outcomes of DCD-NRP LT were comparable to those of DBD LT, despite older donor age. We found that utilization of DCD-NRP grafts allows LT in lower MELD recipients, resulting in reduced intraoperative and postoperative resource utilization while maintaining excellent outcomes.