Revisiting Simultaneous Liver and Kidney Transplantation from Donors After Circulatory Death in the Era of Machine Perfusion Technologies: A US Nationwide Analysis of 10,687 Cases.
DCD donors now account for nearly one-third of all simultaneous liver-kidney transplants.
Revisiting Simultaneous Liver and Kidney Transplantation from Donors After Circulatory Death in the Era of Machine Perfusion Technologies: A US Nationwide Analysis of 10,687 Cases.
Utilization of DCD donors for liver transplantation has increased substantially in the US, and machine perfusion and normothermic regional perfusion were reported to reduce complications, including reperfusion syndrome and early allograft dysfunction.
To evaluate national trends and clinical outcomes of donation after circulatory death (DCD) simultaneous liver-kidney transplantation (simultaneous liver-kidney transplantation) in the US, particularly in the modern era following adoption of machine perfusion (machine perfusion) and normothermic regional perfusion (normothermic regional perfusion).
Using UNOS STAR files, we analyzed 10.687 adult primary simultaneous liver-kidney transplantation performed between 2000 and 2025.
In 2024, liver machine perfusion, kidney machine perfusion, and normothermic regional perfusion were used in 58.1%, 82.9%, and 40.1% of DCD-SLKT cases.
Before matching, recipients in the DBD-SLKT group more frequently required dialysis at transplantation (69.1% vs 54.2%) and were hospitalized preoperatively (51.0% vs 17.2%), and had higher MELD scores (30 vs 23) during 2020-2025.
Liver graft/patient survival were comparable between DCD- and DBD-SLKT regardless of propensity score matching.
Utilization of DCD donors for simultaneous liver-kidney transplantation has increased substantially in parallel with the expanding use of machine perfusion and normothermic regional perfusion, with graft/patient outcomes comparable to those of DBD-simultaneous liver-kidney transplantation regardless of propensity score matching.
However, DBD-simultaneous liver-kidney transplantation recipients had higher baseline preoperative risk. These support broader adoption of DCD donors for simultaneous liver-kidney transplantation in appropriately selected recipients.