Recipient Social Determinants and Geographic Access in DCD Liver Transplantation: Early Lessons During the Perfusion era

Le résumé fourni par la source

BACKGROUND: Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) have expanded donation after circulatory death (DCD) liver transplantation (LT). However, cold ischemia time (CIT) potentially restricts access to DCD LT for recipients living far from transplant centers. The impact of perfusion technology on DCD LT access for geographically distant patients remains underexplored. METHODS: All adult DCD LT at a transplant center from January 2017 to December 2024 were reviewed. Recipients were categorized by perfusion method:static cold storage (SCS) only, NRP, or NMP. Real-world travel distances and times to transplant center were calculated using Google Maps application programming interface. Social determinants of health, including Distressed Community Index (DCI) scores, were assessed. RESULTS: Among 208 DCD LT recipients (n = 80 SCS; n = 106 NRP; n = 22 NMP), median travel distances were 63 (17-122), 61 (23-92), and 156 (78-386) miles for SCS, NRP, and NMP, respectively (NMP versus SCS and NRP, p = 0.043 and 0.010). Median travel times were 1.23 (0.38-2.40), 1.20 (0.50-1.80), and 3.15 (1.58-7.73) h for SCS, NRP, and NMP, respectively (NMP versus .SCS and NRP, P = 0.025 and 0.007). Although DCI distribution did not differ by procurement type, New Mexico (NM) recipients had significantly higher DCI scores (67.7, at risk) than Colorado (CO) recipients (26.7, comfortable) ( P < 0.001). Notably, 21% of NM recipients received NMP LT compared with 7% of CO residents. CONCLUSIONS: An early center experience with DCD LT demonstrates that perfusion technologies facilitated transplantation for geographically vulnerable recipients. NMP recipients on average lived over 2 times farther away and traveled twice as long compared to SCS and NRP recipients. NMP allowed us to mitigate historical barriers of prolonged CIT, especially for recipients from NM, who live further and in highly distressed communities.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.