Donation after circulatory death (DCD) is an increasing source of liver grafts for transplantation, yet outcomes have been inferior compared to donation after brain death liver transplantation. These worse outcomes are mainly due to the severe graft injury resulting from mandatory warm ischemia during DCD organ recovery. New evidence, however, indicates that improved donor selection and surgical techniques can decrease the risk of graft failure and ischemic cholangiopathy (IC). Under current best practices, DCD organs are retrieved with the super-rapid technique, optimizing timing and protecting the liver graft from detrimental warm ischemia. Graft viability is influenced by both the quantity and quality of warm ischemia, which is unique to each donor and causes various degrees of pathophysiologic consequences. Evidence also shows that the choice of preservation solution and premortem heparin administration influences graft viability. Additionally, although the precise mechanism of IC remains unknown, stasis of blood during donor warm ischemia may cause the formation of microthrombi in the peribiliary vascular plexus and ischemia of the bile duct. Importantly, thrombolytic protocols show a possible preventive modality for IC. Finally, while ex vivo machine perfusion technology has gained an interest in DCD liver transplantation, further studies are necessary to evaluate the effectiveness of this evolving field to improve graft quality and transplant outcomes.
Citations
Citations to this article as recorded by
Current Understanding of Marginal Grafts in Liver Transplantation Ze Xiang, Jiarui Li, Huixuan Zeng, Xiaonan Xiang, Fengqiang Gao, Kai Wang, Xuyong Wei, Shusen Zheng, Xiao Xu Aging and disease.2025; 16(2): 1036. CrossRef
Outcomes of Multiorgan Heart Transplant Between Donation After Circulatory Death and Brain Death Toyokazu Endo, Jaimin R. Trivedi, Stephanie Moore, Sheng Fu, Rohan Samson, Michele Gallo, Siddharth Pahwa, Mark S. Slaughter, Erin M. Schumer ASAIO Journal.2025; 71(4): 316. CrossRef
Letter in reference to “Association of Procurement Technique with Organ Yield and Cost Following Donation After Circulatory Death” Lambros Tsonis, Malcolm MacConmara, Magdy Attia, Farhan Zafar American Journal of Transplantation.2025; 25(6): 1372. CrossRef
Advances and Challenges of Thrombolytic Therapy for Donation After Circulatory Death Organs Peng Zhang, Han Liang, Yanfeng Wang Clinical Transplantation.2025;[Epub] CrossRef
Rutaecarpine alleviates hepatic ischemia‒reperfusion injury in liver transplantation by inhibiting inflammatory response and oxidative stress Yan Liu, Feng Qi, Lun-Jian Xiang, Zhu-Jun Yi, Sheng-Wei Li Frontiers in Pharmacology.2025;[Epub] CrossRef
MELD Score Before and After Plasmapheresis in Recipients of ABO-Incompatible Living Donor Liver Transplantation Ja Eun Lee, Sooyeon Lee, Justin Sangwook Ko, Mi Sook Gwak, Gaab Soo Kim Transplantation Proceedings.2025; 57(5): 799. CrossRef
The Impact of Normothermic Machine Perfusion on Biliary Complications in Donation After Circulatory Death Donor Liver Transplantation Rikako Oki, Emily Kerby, Ingrid Rocha, Saleh Al-Juburi, Katsunori Miyake, Guillermo Polanco, Jennifer Orellana, David Ephraim, Adhnan Mohamed, Abbas Al-Kurd, Ahmed Nassar, Atsushi Yoshida, Marwan Abouljoud, Shunji Nagai Transplantation Direct.2025; 11(7): e1821. CrossRef
Intraoperative blood loss as a predictor of outcomes in liver transplantation: determining optimal cutoff values for improved graft survival Ayato Obana, Miho Akabane, Khalid Mumtaz, Kejal Shah, Matthew Hamilton, Rithin Punjala, Austin Schenk, Navdeep Singh, Sylvester Black, Kenneth Washburn, Musab Alebrahim Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
From pixels to prognosis: A comprehensive evidence synthesis on pre-retrieval imaging in deceased and living liver donors Andrea Peloso, Daniel Pietrasz, Charles-Henry Wassmer, Edoardo Maria Muttillo, Beat Moeckli, Rohan Kumar, François Cauchy, Alexis Ricoeur, Philippe Compagnon, Christian Toso Hepatobiliary & Pancreatic Diseases International.2025;[Epub] CrossRef
Better liver transplant outcomes by donor interventions? Amelia J. Hessheimer, Eva Flores, Jordi Vengohechea, Constantino Fondevila Current Opinion in Organ Transplantation.2024; 29(4): 219. CrossRef
Optimizing DCD Liver Grafts With Prolonged Warm Ischemic Time Using Stabilized Plasmin in a Static Cold Storage Orthotopic Rat Liver Transplant Model Riley Kahan, Nader Abraham, Min Zhang, Valery Novokhatny, Isaac Alderete, Paul Cray, Fengming Chen, Qimeng Gao, Greta Cywinska, Ryan Neill, Kentaro Nakata, Ahmed Hassan, Caroline Rush, Jude Penaflor, Justin J. Pollara, Matthew G. Hartwig, Benjamin Hughes, Transplantation Direct.2024; 10(8): e1665. CrossRef
An extensive evaluation of hepatic markers of damage and regeneration in controlled and uncontrolled donation after circulatory death Giuseppina Basta, Fabio Melandro, Serena Babboni, Serena Del Turco, Rudina Ndreu, Francesco Torri, Caterina Martinelli, Beatrice Silvestrini, Adriano Peris, Chiara Lazzeri, Fabio Guarracino, Riccardo Morganti, Paolo Maremmani, Pietro Bertini, Paolo De Sim Liver Transplantation.2023; 29(8): 813. CrossRef
Anesthetic Considerations of Organ Procurement After Brain and Cardiac Death: A Narrative Review Michael B Brown, Apolonia E Abramowicz, Peter J Panzica, Garret Weber Cureus.2023;[Epub] CrossRef
DCD liver transplant in patients with a MELD over 35 Raphael P. H. Meier, Miguel Nunez, Shareef M. Syed, Sandy Feng, Mehdi Tavakol, Chris E. Freise, John P. Roberts, Nancy L. Ascher, Ryutaro Hirose, Garrett R. Roll Frontiers in Immunology.2023;[Epub] CrossRef
Comparison of Biliary Complications Rates After Brain Death, Donation After Circulatory Death, and Living-Donor Liver Transplantation: A Single-Center Cohort Study Raphael Pascal Henri Meier, Yvonne Kelly, Hillary Braun, Daniel Maluf, Chris Freise, Nancy Ascher, John Roberts, Garrett Roll Transplant International.2022;[Epub] CrossRef
The first successful report of liver transplantation from category III donation after circulatory death in South Korea: a case report Incheon Kang, Jae-myeong Lee, Jae Geun Lee Korean Journal of Transplantation.2022; 36(4): 294. CrossRef
Extended criteria grafts and emerging therapeutics strategy in liver transplantation. The unstable balance between damage and repair Davide Ghinolfi, Fabio Melandro, Francesco Torri, Caterina Martinelli, Valentina Cappello, Serena Babboni, Beatrice Silvestrini, Paolo De Simone, Giuseppina Basta, Serena Del Turco Transplantation Reviews.2021; 35(4): 100639. CrossRef
The Immunological Basis of Liver Allograft Rejection Vincenzo Ronca, Grace Wootton, Chiara Milani, Owen Cain Frontiers in Immunology.2020;[Epub] CrossRef
Antibody mediated rejection (AMR) after adult ABO-incompatible living donor liver transplantation (ABO-I LDLT) induced hepatic necrosis or diffuse intrahepatic biliary complications, which were related with poor graft and patient survival. Various desensitization protocols have been used to overcome these problems. Since using rituximab, the outcomes of ABO-I LDLT show a similar survival rate to those of ABO-compatible living donor liver transplantation. However, diffuse bile duct complications still occur after ABO-I LDLT. We have reviewed the past and current immune strategies for desensitization and to provide outcomes and ABO incompatibility-related complications in ABO-I LDLT.
Citations
Citations to this article as recorded by
Heterogeneity and plasticity of cholangiocytes in liver injury: a journey from pathophysiology to therapeutic utility Chengtao Lou, Tianchen Lan, Shengjun Xu, Xinhao Hu, Jiarui Li, Ze Xiang, Shengda Lin, Xiaohui Fan, Jian Chen, Xiao Xu Gut.2026; 75(3): 646. CrossRef
Outcomes of Highly Urgent ABO-Incompatible Living Donor Liver Transplantation in National Databases Jongman Kim, Sang Jin Kim, Boram Park, Kyunga Kim, YoungRok Choi, Geun Hong, Jun Yong Park, Young Seok Han, Nam-Joon Yi, Seung Heui Hong, Soon-Young Kim, Jungbun Park, Youngwon Hwang, Dong-Hwan Jung Journal of Korean Medical Science.2026;[Epub] CrossRef
Five decades of clinical ABO-incompatible liver transplantation research: a bibliometric analysis Maiwulanjiang Maimaiti, Alimujiang Mamuti, Yilizhati Azhati, Aliya Tulading, Yun-Fei Zhang, Jing Wu, Abudusalamu Tuersunmaimaiti, Chun-Hui Lv, Gang Yao, Amina Aierken, Tao Li, Tuerganaili Aji, Ying-Mei Shao, Hao Wen, Tuerhongjiang Tuxun International Journal of Surgery.2025; 111(1): 1508. CrossRef
Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases Nalini Kanta Ghosh, Kausar Makki, Yogesh Yadav, Tathagata Karan, Piyush Srivastava, Anil Agarwal, Vivek Vij Clinical Transplantation and Research.2025; 39(2): 161. CrossRef
Immunology demystified: A guide for transplant hepatologists Iva Kosuta, Tomislav Kelava, Ana Ostojic, Vibor Sesa, Anna Mrzljak, Hrvoje Lalic World Journal of Transplantation.2024;[Epub] CrossRef
Impact of Preformed Donor-specific Antibodies in Comparison to ABO Incompatibility in Living Donor Liver Transplantation: A Propensity Score–Matched Analysis Jiyoung Kim, Suk Kyun Hong, Jae-Yoon Kim, Jaewon Lee, Hyun Hwa Choi, Minseob Kim, Youngjin Kim, Su young Hong, Jeong-Moo Lee, YoungRok Choi, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh Transplantation.2024; 108(9): e229. CrossRef
Human umbilical cord mesenchymal stem cells alleviate fatty liver ischemia‐reperfusion injury by activating autophagy through upregulation of IFNγ Chenhao Xu, Xixi Fang, Bei Lu, Yisu Song, Wenzhi Shu, Zhengyang Lu, Renyi Su, Ze Xiang, Xiao Xu, Xuyong Wei Cell Biochemistry and Function.2024;[Epub] CrossRef
Bile duct diffusion-weighted image hyperintensity predicts intrahepatic biliary complications after ABO-incompatible liver transplantation Kyowon Gu, Woo Kyoung Jeong, Dong Ik Cha, Jeong Ah Hwang, Jinsoo Rhu, Jong Man Kim, Gyu-Seong Choi, Sun-Young Baek European Radiology.2024; 35(1): 393. CrossRef
Impact of Baseline Anti-ABO Antibody Titer on Biliary Complications in ABO-Incompatible Living-Donor Liver Transplantation Se-Hyeon Yu, Hye-Sung Jo, Young-Dong Yu, Pyoung-Jae Park, Hyung-Joon Han, Sang-Jin Kim, Syahrul Hadi Kamarulzaman, Dong-Sik Kim Journal of Clinical Medicine.2024; 13(16): 4789. CrossRef
Consecutive disruption of intrahepatic bile ducts after ABO-incompatible living-donor re-liver transplantation: A case report Akihiko Soyama, Baglan Askeyev, Takanobu Hara, Hajime Matsushima, Tomohiko Adachi, Susumu Eguchi International Journal of Surgery Case Reports.2024; 125: 110606. CrossRef
Outcomes of emergency pediatric ABO-incompatible living donor liver transplantation in Korea Sunghyo An, Jongman Kim, Sang Jin Kim, Soon-Young Kim, Jung-Bun Park, Youngwon Hwang, Dong-Hwan Jung Annals of Liver Transplantation.2024; 4(2): 63. CrossRef
The fate of donor‐type ABO blood group antigen expression in liver grafts in ABO‐incompatible adult living donor liver transplantation Moon Young Oh, Haeryoung Kim, Nam‐Joon Yi, Suyoung Hong, Jeong‐Moo Lee, Sola Lee, Suk Kyun Hong, YoungRok Choi, Kwang‐Woong Lee, Kyung‐Suk Suh Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(7): 871. CrossRef
Strategies for ABO Incompatible Liver Transplantation Shekhar S. Jadaun, Shaleen Agarwal, Subhash Gupta, Sanjiv Saigal Journal of Clinical and Experimental Hepatology.2023; 13(4): 698. CrossRef
Single-dose eculizumab as part of a modified desensitization protocol for ABO-incompatible living donor liver transplantation Mario Spaggiari, Egor Petrochenkov, Giulia Bencini, Sujata Gaitonde, Jamie Benken, Grace Guzman, Jamie Berkes, Ivo Tzvetanov, Enrico Benedetti Liver Transplantation.2023; 29(8): 906. CrossRef
Pretransplant mycophenolate mofetil may be associated with reduced intrahepatic cholangiopathy in ABO-incompatible liver transplantation Jinsoo Rhu, Jong Man Kim, Gyu-seong Choi, Jae-Won Joh Liver Transplantation.2023; 29(8): 849. CrossRef
Advances and innovations in living donor liver transplant techniques, matching and surgical training: Meeting report from the living donor liver transplant consensus conference Mark Sturdevant, Swaytha Ganesh, Benjamin Samstein, Elizabeth C. Verna, Manuel Rodriguez‐Davalos, Vineeta Kumar, Marwan Abouljoud, Oya Andacoglu, Medhat Askar, Dieter Broering, Juliet Emamaullee, Jean C. Emond, Christine E. Haugen, Michelle T. Jesse, Mure Clinical Transplantation.2023;[Epub] CrossRef
Association between the early high level of serum tacrolimus and recurrence of hepatocellular carcinoma in ABO-incompatible liver transplantation Ji Won Han, Jong Young Choi, Eun Sun Jung, Ji Hoon Kim, Hee Sun Cho, Jae-Sung Yoo, Pil Soo Sung, Jeong Won Jang, Seung Kew Yoon, Ho Joong Choi, Young Kyoung You World Journal of Gastrointestinal Surgery.2023; 15(12): 2727. CrossRef
ABO-Incompatible Living Donor Liver Transplant From a Blood Type A2 Donor to a Type B Recipient: A Note of Caution Yogesh Puri, Ashwin Rammohan, Deepti Sachan, Mukul Vij, Mohamed Rela Experimental and Clinical Transplantation.2022; 20(1): 100. CrossRef
Healthy Spouses can be Considered as Living Liver Donors Okjoo Lee, Jong Man Kim, Sang Jin Kim, Jinsoo Rhu, Gyu‐Seong Choi, Jae‐Won Joh World Journal of Surgery.2022; 46(6): 1474. CrossRef
Mesenchymal Stem Cells and Their Small Extracellular Vesicles as Crucial Immunological Efficacy for Hepatic Diseases Yuting Tang, Peipei Wu, Linli Li, Wenrong Xu, Jiajia Jiang Frontiers in Immunology.2022;[Epub] CrossRef
Overcoming high pre-transplant isoagglutinin titers using high-dose intravenous immunoglobulin, salvage plasmapheresis, and booster rituximab without splenectomy in ABO-incompatible living donor liver transplantation: a case report Hyung Hwan Moon Kosin Medical Journal.2022; 37(2): 163. CrossRef
Real‐world clinical features, health‐care utilization, and economic burden in decompensated cirrhosis patients: A national database Hankil Lee, Beom Kyung Kim Journal of Gastroenterology and Hepatology.2022; 37(11): 2154. CrossRef
New Evidence of Oral Branched-Chain Amino Acid Supplementation on the Prognosis of Patients With Advanced Liver Disease Hankil Lee, Jeong-Ju Yoo, Sang Hoon Ahn, Beom Kyung Kim Clinical and Translational Gastroenterology.2022; 13(12): e00542. CrossRef
Fatal intracardiac and pulmonary arterial thromboembolic damage following ABO-incompatible living donor liver transplantation for autoimmune hepatitis Won Kyu Choi, Junghan Kim, Ho Joong Choi, Sang Hyun Hong, Min Suk Chae Medicine.2021; 100(2): e24298. CrossRef
Differences in Bile Microbiology and Antibiotic Resistances between Liver Transplant Recipients and Non-Transplant Patients Eunhye Kang, Suk-Won Suh, Seung Eun Lee, Yoo Shin Choi, Seong-Ho Choi, Bo-Ram Lee, YoungRok Choi, Jaehong Jeong Surgical Infections.2021; 22(7): 741. CrossRef
Impact of Graft Weight Change During Perfusion on Hepatocellular Carcinoma Recurrence After Living Donor Liver Transplantation Jong Man Kim, Young Jae Chung, Sangjin Kim, Jinsoo Rhu, Gyu-Seong Choi, Jae-Won Joh Frontiers in Oncology.2021;[Epub] CrossRef
ABO-incompatible living donor liver transplantation with high preoperative antibody titer Yoshikatsu Saitoh, Atsushi Fujio, Shigehito Miyagi, Kazuaki Tokodai, Michiaki Unno, Takashi Kamei International Journal of Surgery Case Reports.2021; 85(C): 106260. CrossRef
ABO Incompatible Liver Transplantation in Children: A 20 Year Experience from Centres in the TransplantChild European Reference Network Małgorzata Markiewicz-Kijewska, Piotr Kaliciński, Juan Torres Canizales, Angelo Di Giorgio, Ulrich Baumann, Carl Jorns, Alastair Baker, Maria Francelina Lopes, Esteban Frauca Remacha, Eduardo Lopez-Granados, Paloma Jara Vega, Maria-Sole Basso, Grzegorz Ko Children.2021; 8(9): 760. CrossRef
The Human Immune Response to Cadaveric and Living Donor Liver Allografts Angus Hann, Daniel-Clement Osei-Bordom, Desley A. H. Neil, Vincenzo Ronca, Suz Warner, M. Thamara P. R. Perera Frontiers in Immunology.2020;[Epub] CrossRef
Comparison of clinical outcomes between ABO-incompatible and ABO-compatible pediatric liver transplantation: a systematic literature review and meta-analysis Zhong-Yu Kang, Wei Liu, Dai-Hong Li Pediatric Surgery International.2020; 36(11): 1353. CrossRef
Characteristics of Immunoglobulin M Type Antibodies of Different Origins from the Immunologic and Clinical Viewpoints and Their Application in Controlling Antibody-Mediated Allograft Rejection Yoshiko Matsuda, Takahisa Hiramitsu, Xiao-kang Li, Takeshi Watanabe Pathogens.2020; 10(1): 4. CrossRef
First
Prev
