Introduction: An under-utilized demographic in liver transplantation is the CDC high-risk donor (HRD). These individuals, considered at higher risk of blood-borne diseases, contribute approximately 9% of donated organs. Surveys of transplant providers show that these organs are frequently passed over for fear of viral transmission, with 8% of transplant providers refusing to use HRD organs. This reluctance to use HRD organs can result in longer wait list times and more ill recipients. We aim to show improved outcomes with CDC HRD organs, largely due to the younger, healthier nature of these donors.

Methods: A database review of deceased donor primary solitary liver transplants as reported to the Organ Procurement and Transplantation Network database from October 31, 1987 to December 31, 2013 was performed. Analysis was restricted to patients for whom the HRD status of the donor was reported for a sample size of 55,816 total patients. Median follow-up time was 33 months. Demographics on age, gender, and comorbidities were collected for each group. Results were controlled for recipient comorbidities. Statistical analysis was performed using Fisher's exact test and logistic regression in R statistical software.

Results: The high risk donors were significantly less likely to have a history of diabetes, hypertension, or a myocardial infarction (p<0.05). They were also a younger population (34 in HRD vs. 39, p<0.05). The high risk donors were less likely to have rejected their graft at 6 (11.4 vs. 13.1%, p<0.05) or 12 (14.1 vs. 15.4%, p<0.05) months compared to non-high risk. Graft failure was also decreased (23.6 vs. 27.3%, p<0.05) in the high risk group; strikingly, mortality was significantly less (20.4 vs. 22.3%) in recipients of high risk grafts. When controlled for comorbidities, these differences disappeared.

Conclusions: CDC high risk donors are an under-utilized source of liver grafts. Despite studies showing low rates of viral transmission, many transplant providers avoid these donors. We have demonstrated that rates of rejection within the first year, graft failure, and death are lower in recipients of HRD organs. When controlled for comorbidities, these differences lose significance, indicating that younger age and fewer comorbidities in these patients likely play a role in the differences in outcomes. We recommend that transplant surgeons carefully evaluate the risk of viral transmission in light of the decreased graft failure and mortality.

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