We hypothesized that CDC high risk donors (HRD) might be younger than non-HRD and have other characteristics associated with favorable outcomes after liver transplant (LT). The current analysis compares patient and graft survival after LT using HRD vs non-HRD grafts.

METHODS: We used the SRTR database and looked at adult, initial, liver alone transplants after February of 2002. We excluded recipients of living donor, DCD or split liver grafts. We also excluded donor livers that were HCV positive. There were with 29767 noHRD and 3681 HRD. Groups were compared for demographics and for survival using Kaplan-Meier log rank tests. Multivariate cox regression models were used to identify factors associated with survival.

RESULTS: Compared to noHRD, HRD were younger (32.2 ± 10.8 vs 34.9 ± 13.1: p<0.001), more likely to be white (70.3% vs 66.1%: p<0.001) and more likely to be male (70.2% vs 61.4%: p<0.001). Compared to noHRD recipients, HRD recipients were older (54.1 ± 10.1 vs 53.6 ± 10.3: p=0.002), more likely to be male (70.1% vs 67.3%: p=0.001), more likely to have diabetes (24.1% vs 22.6%: p=0.046), more likely to have HCV (48.4% vs 46.0%: p=0.009), and HCC (26.8% vs 24.4%: p=0.002) and had shorter cold ischemia times (6.75 ± 3.2 hours vs 6.92 ± 3.3: p=0.004). There were no differences in calculated MELD score or creatinine or hospitalization at transplant. Compared to recipients of noHRD, recipients of HRD had comparable patient survival at 1 year (89.1% vs 89.0%: NS) and 3 years (75.5% vs 76.9%: NS) and comparable graft survival at 1 year (87.2% vs 86.0%: NS) and 3 years (72.3% vs 72.7%: NS). On multivariate analysis, the use of HRD was not associated with patient death (HR 1.01: CI 0.92-1.10: NS) or graft loss (HR 0.95: 0.88-1.03: NS). Recipient factors associated with both graft and patient loss included age, African-American race, creatinine, diabetes, HCV, HCC, cold ischemia time and being hospitalized at transplant.

CONCLUSIONS: HRD were in fact younger than noHRD but their grafts were more likely to be used in older recipients with higher rates of diabetes and HCV. There were no differences in patient and graft survival in recipients of HRD livers vs noHRD livers. Centers may find this observation reassuring to potential recipients when discussing the option of an HRD liver.

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