Cumulative United States Experience in Domino Liver Transplants
Surgery, State University of New York, Downstate, Brooklyn, CA.
Meeting: 2018 American Transplant Congress
Abstract number: A291
Keywords: Allocation, Donation, Liver, Survival
Session Information
Session Name: Poster Session A: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Background/Purpose: The ongoing shortage of livers in the setting of growing waiting lists remains a challenge in transplantation. First introduced in 1995, sequential or domino liver transplantation offers a way for patients with amyloidosis to undergo a deceased donor liver transplant and utilize their native liver for a different patient with liver failure. The reported experience in domino liver transplants is limited to case series. Long term analysis from a national US cohort is yet to be described.
Methods: Between 1996 to 2016, 179 domino liver transplants were reported to UNOS from 38 centers. Demographics of donor and recipients of domino living liver transplants were analyzed. Overall actuarial survival and liver graft failure were estimated using Kaplan-Meier. The 20 year period was divided into 3 eras (1995-01, 2002-08, 2009-16) and overall and graft survival were compared using log-rank test.
Results: Demographics are summarized in Table 1 and 2. Most recipients (95%) underwent a primary transplant; 158 recipients (89.27%) arrived from home; 16 (9.04%) were non-ICU and 3 (1.69%) ICU inpatients. The most common reason for transplant in recipients was cirrhosis (69.27%), followed by liver malignancy (21.23%), and metabolic disease (2.23%). Recipient MELD score was 14 (SD 6). Overall survival and graft failure rates were similar between recipients and donors. Although there was a trend towards improved overall and graft survival in the last era (2009-16), this was not statistically significant. Pediatric (n=12) overall and graft survival at 5 years was 100%.
| Recipient Demoraphics | |
| Race
White Black Hispanic Asian |
–
142 (79.3%) 9 (5.0%) 12 (6.7%) 14 (7.8%) |
| Transplant
Primary Secondary Tertiary |
–
170 (95.0%) 7 (3.9%) 2 (1.1%) |
| Age
Adult Pediatric |
–
167 (93.3%) 12 (6.7%) |
| Recipients n=179 | Donors n=179 | |
| Sex
Male |
–
114 (63.7%) |
–
118 (65.9%) |
| Average Age years (SD) | 55.4 (16.1) | 46.7 (16.6) |
| Overall Survival
1 year 5 year 10 years |
–
88.0% 70.6% 49.0% |
–
93.3% 70.65% 46.21% |
| Graft Failure
1 year 5 year 10 years |
–
14.7% 33.1% 54.9% |
–
9.2% 30.0% 51.0% |
Conclusion:
Domino liver transplants are a safe strategy for increasing availability of livers with comparable survival and graft failure rates long term. Pediatric recipients have improved outcomes. Further long-term follow up in this population is warranted.
CITATION INFORMATION: Barrera K., Sharma S., Gruessner A., Gruessner R. Cumulative United States Experience in Domino Liver Transplants Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Barrera K, Sharma S, Gruessner A, Gruessner R. Cumulative United States Experience in Domino Liver Transplants [abstract]. https://atcmeetingabstracts.com/abstract/cumulative-united-states-experience-in-domino-liver-transplants/. Accessed November 24, 2024.« Back to 2018 American Transplant Congress