Long-Term Outcomes of Donation After Circulatory Death Liver Transplantation in Paediatric Recipients: A 20-Year Single-Center Experience

Background/Objectives: Donation after circulatory death (DCD) grafts represent an increasingly important source of donor organs for paediatric liver transplantation; however, long-term outcomes remain incompletely defined. We aimed to evaluate long-term patient and graft survival, and post-transplant complications following paediatric DCD liver transplantation over a 20-year period. Methods: We performed a retrospective single-center study of paediatric recipients (<18 years) who underwent liver transplantation using DCD grafts at King’s College Hospital between 2002 and 2023. Donor selection was based on favourable graft appearance and minimization of functional warm ischaemic time. Patient and graft survival were analysed using Kaplan–Meier methods and post-transplant complications were assessed. Results: Sixty paediatric recipients underwent DCD liver transplantation during the study period. Forty-two grafts (70%) were from paediatric donors and 18 (30%) from adult donors. Median recipient age was 9 years. Overall patient survival at 1, 5, and 10 years was 96.2%, 96.2%, and 92.7%, respectively: corresponding graft survival was 96.6%, 91.7%, and 84.6%. Five recipients whose first liver transplant was performed using a paediatric DCD graft subsequently required retransplantation. There were no cases of primary non-function or ischaemic cholangiopathy. Hepatic artery thrombosis occurred in two recipients. Conclusions: Paediatric liver transplantation using DCD grafts was associated with favourable long-term patient survival and a low incidence of major complications. These findings support the continued use of DCD grafts as an important source of donor organs for paediatric recipients.