Post-transplant outcomes and financial burden of donation after circulatory death donor liver transplant after the implementation of acuity circle policy
Recommended Citation
Shimada S, Yoshida A, Abouljoud M, Miyake K, Ivanics T, Shamaa T, Venkat D, Moonka D, Trudeau S, Reed E, and Nagai S. Post-transplant outcomes and financial burden of donation after circulatory death donor liver transplant after the implementation of acuity circle policy. Clin Transplant 2023; e15190.
Document Type
Article
Publication Date
1-1-2024
Publication Title
Clinical transplantation
Keywords
Adult, Humans, Liver Transplantation, Financial Stress, Graft Survival, Living Donors, Tissue Donors, Cardiovascular System, Retrospective Studies, Tissue and Organ Procurement, Death, Brain Death
Abstract
BACKGROUND: After implementation of the Acuity Circles (AC) allocation policy, use of DCD liver grafts has increased in the United States.
METHODS: We evaluated the impact of AC on rates of DCD-liver transplants (LT), their outcomes, and medical costs in a single practice. Adult LT patients were classified into three eras: Era 1 (pre-AC, 1/01/2015-12/31/2017); Era 2 (late pre-AC era, 1/01/2018-02/03/2020); and Era 3 (AC era, 05/10/2020-09/30/2021).
RESULTS: A total of 520 eligible LTs were performed; 87 were DCD, and 433 were DBD. With each successive era, the proportion of DCD increased (Era 1: 11%; Era 2: 20%; Era 3: 24%; p < .001). DCD recipients had longer ICU stays, higher re-admission/re-operation rates, and higher incidence of ischemic cholangiopathy compared to those with DBD. Direct, surgical, and ICU costs during first admission were higher with DCD than DBD (+8.0%, p < .001; +4.2%, p < .001; and +33.3%, p = .001). DCD-related costs increased after Era 1 (Direct: +4.9% [Era 2 vs. 1] and +12.4% [Era 3 vs. 1], p = .04; Surgical: +17.7% and +21.7%, p < .001). In the AC era, there was a significantly higher proportion of donors ≥ 50 years, and more national organ sharing. Compared to DCD from donors <50 years, DCD from donors ≥ 50 years was associated with significantly higher total direct, surgical, and ICU costs (+12.6%, p = .01; +9.5%, p = .01; +84.6%, p = .03).
CONCLUSIONS: The proportion of DCD-LT, especially from older donors, has increased after the implementation of AC policies. These changes are likely to be associated with higher costs in the AC era.
Medical Subject Headings
Adult; Humans; Liver Transplantation; Financial Stress; Graft Survival; Living Donors; Tissue Donors; Cardiovascular System; Retrospective Studies; Tissue and Organ Procurement; Death; Brain Death
PubMed ID
37964683
ePublication
ePub ahead of print
Volume
38
Issue
1
First Page
15190
Last Page
15190
