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Cohort studyAnnals of surgery · 2026

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.

Jiro Kusakabe, Eduardo Fernandes, Kalyan Ram Bhamidimarri … Antonio Pinna

NephrologyCohort study

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.

Jiro Kusakabe et al. · Annals of surgery · 2026

Background

Utilization of DCD donors for liver transplantation has increased substantially in the US, and MP and NRP were reported to reduce complications, including reperfusion syndrome and early allograft dysfunction.

Purpose

To evaluate national trends and clinical outcomes of donation after circulatory death (DCD) simultaneous liver-kidney transplantation (SLKT) in the US, particularly in the modern era following adoption of machine perfusion (MP) and normothermic regional perfusion (NRP).

Methods

Using UNOS STAR files, we analyzed 10.687 adult primary SLKT performed between 2000 and 2025.

29.3%

Results

nearly one-third of simultaneous liver-kidney transplants use donors whose hearts stopped

More results

In 2024, liver MP, kidney MP, and NRP 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.

More results

Liver graft/patient survival were comparable between DCD- and DBD-SLKT regardless of PSM.

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Conclusion · 1 of 2

Utilization of DCD donors for SLKT has increased substantially in parallel with the expanding use of MP and NRP, with graft/patient outcomes comparable to those of DBD-SLKT regardless of PSM.

Conclusion · 2 of 2

However, DBD-SLKT recipients had higher baseline preoperative risk. These support broader adoption of DCD donors for SLKT in appropriately selected recipients.

Post

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.

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