Decision modelling in donation after circulatory death (DCD) liver transplantation.

Kenneth A. Mclean, Julian Camilleri-Brennan, Stephen R Knight, Thomas Drake, Riinu Ots, Catherine Shaw, Stephen Wigmore, Ewen Harrison

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Introduction: Donation after circulatory death (DCD) liver allografts are increasingly used for transplantation. However, the post-transplantation clinical and quality of life outcomes of DCD recipients are traditionally considered to be inferior compared with donation after brain death (DBD) allograft recipients. Decision making for such marginal organs can be difficult. This study investigated the optimal decision to accept or decline a DCD liver allograft for a patient based on their current health. Methods: A Markov decision process model was constructed to predict the 5 year clinical course of patients on the liver transplant waiting list. Clinical outcomes were determined from the UK Transplant registry or appropriate literature. Quality-adjusted life years (QALYs) were determined using the condition-specific “Short form of liver disease quality of life” (SF-LDQOL) questionnaire. Results: There were 293 / 374 (78.3%) eligible patients who completed the SF-LDQOL questionnaire. Seventy-three respondents (24.9%) were pre-transplant and 220 were post-transplant (DBD-recipient, 57.0%; DCD-recipient, 10.2%; re-transplant recipient, 7.9%). Predictive modelling indicated that quality-adjusted life years (QALYs) gained at 5 years were significantly higher in DCD-recipients (3.77, 95% CI=3.44–4.10) compared to those who remained on the waiting list for a DBD transplant with model of end-stage liver disease (MELD) scores of 15-20 (3.36, 95% CI=3.28–3.43), or >20 (3.07, 95% CI=3.00–3.14). There was no significant advantage for individuals with MELD scores <15 (3.55, 95% CI=3.47–3.63). Conclusion: This model predicts that patients on the UK liver transplant waiting list with MELD scores >15 should receive an offered DCD allograft based on the QALYs gained at 5 years. This analysis only accounts for donor-recipient risk pairings seen in current practice. The optimal decision for patients with MELD scores <15 remains unclear, however a survival benefit was observed when a DCD organ was accepted.
Original languageEnglish
Pages (from-to)594-603
Number of pages10
JournalLiver Transplantation
Volume23
Issue number5
Early online date27 Dec 2016
DOIs
Publication statusPublished - May 2017

Keywords / Materials (for Non-textual outputs)

  • QUALITY-OF-LIFE
  • CARDIAC DEATH
  • ISCHEMIC CHOLANGIOPATHY
  • WAITING-LIST
  • LIVING-DONOR
  • RISK-FACTORS
  • EXPERIENCE
  • OUTCOMES

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