Utilization of liver grafts obtained from donation after medical assistance in dying: A Canadian multicenter experience

作者：Alessandro Parente, Kevin Verhoeff, Samrat Ray, Markus Selzner, Trevor Reichman, M. Bleszynski, Maja Segedi, Juan Glinka, Ephraim Tang, Olivia Ganescu, Magan Solomon, Jeffrey Barkun, Prosanto Chaudhury, Steven Paraskevas, George Zogopoulos, Juan Santiago Rubio, Boris Gala-López, Khaled Dajani, A. M. James Shapiro · 发表于：Journal of Hepatology · 年份：2025 · DOI：10.1016/j.jhep.2025.08.039 · 被引用次数：2 · 研究领域：Organ Transplantation Techniques and Outcomes、Liver Disease and Transplantation、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND & AIMS: Given country-specific variance in legislation, limited information is available regarding outcomes of liver transplantation (LT) using medical assistance in dying (MAiD) donation after circulatory death (DCD type-V) grafts. We compared outcomes following LT using DCD type-V vs. conventional DCD type-III grafts. METHODS: We reviewed all LTs using DCD-V and DCD-III donors performed across Canadian provinces between 2016 (MAiD legalization) and 2023. Primary outcomes were patient and graft survival at 1, 3, and 5 years. Secondary outcomes included early allograft dysfunction, length of stay, postoperative complications, and biliary complications. RESULTS: Among 313 recipients, 56 (17.9%) received DCD-V and 257 (82.1%) DCD-III grafts. DCD-V donors were older (56 vs. 38 years, p <0.0001), and had similar warm ischemic time (20 vs. 23 min, p = 0.190). Patient survival for DCD-V was 89.3%, 85.7%, and 85.7% at 1, 3, and 5 years, with graft survival of 82.1%, 78.6%, and 78.6%, comparable to DCD-III. DCD-V was not associated with graft loss (odds ratio 1.64; 95% CI 0.66-4.08), which was confirmed by multivariable Cox regression analysis (hazard ratio 1.53; 95% CI 0.74-3.15). Early allograft dysfunction occurred more frequently with DCD-III (57.5% vs. 42.9%, p = 0.047), whereas length of stay was longer with DCD-V (21.5 vs. 15 days, p = 0.011). Overall complication rates were similar; biliary complications were more common in DCD-V, but this was not statistically sig...