Utilization of pre‐procurement biopsy in donation‐after‐circulatory death ( DCD ) liver transplantation

We perform routine pre-procurement image-guided percutaneous liver biopsies on potential DCD liver donors. The purpose of this study was to examine the impact of pre-procurement liver biopsy on utilization of livers from DCD donors.We retrospectively reviewed demographics, liver histology, and disposition of DCD liver donors within a single organ procurement organization (OPO) who underwent pre-procurement liver biopsy from January 2000 through December 2019.Two hundred twelve potential donors underwent pre-recovery biopsy. No donors were lost due to complications of biopsy. Of these, 183 (86.3%) had acceptable biopsies; 146 (79.8%) were successfully transplanted and 37 (20.2%) were deemed not suitable for transplant. In contrast, of 120 DCD livers recovered with the intent to transplant that were not biopsied prior to recovery, 59 (49.2%) were successfully transplanted and 61 (50.8%) were deemed not suitable for transplant. Fourteen donors were ruled out for transplant based on pre-recovery histology. Successfully transplanted livers that underwent pre-procurement biopsy were more likely to come from donors over age 50 or with BMI over 30 compared to successfully transplanted livers without a pre-recovery biopsy.Biopsy excluded 6.6% of DCD donor livers for transplant prior to recovery and facilitated the successful recovery and transplant of two-thirds of potential DCD donor livers. Livers intended for transplant at the time of recovery that did not undergo pre-procurement biopsy were more likely to not be recovered or to be discarded. Pre-procurement biopsy provides additional histologic information prior to deploying resources, and helps to identify usable livers that might otherwise be declined for transplant. Consideration of liver biopsy in this group benefits OPOs and transplant centers by maximizing organ utilization and optimizing resource deployment.