Careful graft and recipient selection have resulted in improved outcomes in liver transplantation (LT) using donation after cardiac death (DCD) organs. The UK DCD Risk Score was established as a risk stratification tool to guide selection. We evaluated the applicability of the UK DCD Risk Score in a contemporary US cohort of adult DCD LT recipients using the United Network for Organ Sharing registry (2011-2020). 3,899 DCD LTs were included in our study (UK DCD Risk Score 0–5 points: 1,438 [36.9%], 6–9 points: 1,920 [49.2%]; 10–20 points: 541 [13.9%]). Compared to a score of 6–9 points, a score of 0–5 points was associated with decreased risk of graft loss (HR = 0.80, 95%CI: 0.68-0.94, P = 0.006), while a score of 10–20 points was associated with increased risk of graft loss (HR = 1.23, 95%CI: 1.01-1.51, P = 0.04). The 5-year graft survival for patients with risk scores of 0–5, 6–9, and 10–20 were 75.9%, 71.7%, and 67.9%, respectively. The C-statistic for the UK DCD Risk Score in our contemporary cohort was 0.611. The UK DCD Risk Score demonstrates a more limited ability to differentiate recipient outcomes in the modern era of DCD LT in the US. Acceptable long-term outcomes are achievable for patients stratified to the highest-risk group.

This article is protected by copyright. All rights reserved