Surgical Categorization Improve Outcomes and Organ Utilization in Liver Transplant

H. Bohorquez,^1,2 H. Sharma,¹ D. Bruce,¹ A. Cohen,^1,2 C. Carmody,^1,2 J. Seal,¹ E. Bugeaud,¹ D. Sonnier,¹ A. Mathur,¹ D. Marroquin,¹ M. Voltz,¹ D. Lucia,¹ G. Loss.^1,2

¹Multi-Organ Transplant Institute, Ochsner Helath System, New Orleans, LA
²School of Medicine, University of Queensland, New Orleans, LA.

Meeting: 2018 American Transplant Congress

Abstract number: C234

Keywords: Allocation, Liver transplantation, Risk factors, Waiting lists

Session Information

Session Name: Poster Session C: Liver: Recipient Selection

Session Type: Poster Session

Date: Monday, June 4, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Background: Liver transplant (LT) varies greatly in technical complexity due to factors such as prior surgery, obesity, and portal vein thrombosis (PVT). This must be taken into account when considering organ offers.

In 2015, we began using an A/B/C stratification of predicted surgical complexity based on surgical history and cross-sectional imaging. The scores are assigned at waitlist addition and are integral to on-call workflow.

Methods: Four-hundred consecutives LT recipients (Jan,15 -Dec,16) were categorize at the time of listing according with their surgical complexity in Group A: Low (n=268) LT alone, absence-moderate obesity; patent PV, no upper abdomen surgeries (except lap chole); Group B: Moderate (n=91) combined LKT, moderate–severe obesity, upper abdomen operations, PV thrombosis; and Group C: High (n=41) retransplantation, previous HB surgery or gastric bypass, PV cavernous transformation. Analysis were performed using Student t-test, Fisher exact test, Kaplan Meier method and log rank test.

Results: Recipients in group A had lower MELD (19.5+8.3 vs. 20.4+9.3 vs. 24.8+9.6 P=0.001) while recipients in group B had higher BMI (27.2+5.4 vs. 33.1+8 vs. 26.9+5.1 p=0.002) and high proportion of HCC (32% vs. 46% vs. 17% p=0.02). Group C had the higher incidence of previous LT (2.4% vs. 1.1% vs. 26.8% p<0.001), PV thrombosis (7.8% vs. 12% vs. 29% p=0.002) and operation time was longer (5.3+1.6 vs. 5.5+1.3 vs. 6.4+2.1 p<0.001).

Compared with group C, group A had a similar proportion livers from of out DSA (57.8% vs. 43.9% vs. 58.9% p=0.7) but received more DCD livers (12.7% vs. 5.5% vs. 0% p=0.02) and higher donor risk index livers (1.6+0.4 vs. 1.4+0.4 vs. 1.3+0.2 p<0.001).

Waiting time, cold ischemia time, donor liver steatosis, incidence of early allograft dysfunction and, biliary and vascular complications were similar in all 3 groups.

One-year graft and patient survival were 91.8% vs. 87.9% vs. 78.1% (p=0.006) and 93.3% vs. 91.2% vs. 78.1% (p=0.001) for groups A, B, C.

Conclusion: Pre LT categorization by surgical complexity correctly stratified surgical risk. Also, use of surgical complexity categories improve outcomes and organ utilization by better recipient-donor matching and facilites consistent decision making in a timely manner.

CITATION INFORMATION: Bohorquez H., Sharma H., Bruce D., Cohen A., Carmody C., Seal J., Bugeaud E., Sonnier D., Mathur A., Marroquin D., Voltz M., Lucia D., Loss G. Surgical Categorization Improve Outcomes and Organ Utilization in Liver Transplant Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Bohorquez H, Sharma H, Bruce D, Cohen A, Carmody C, Seal J, Bugeaud E, Sonnier D, Mathur A, Marroquin D, Voltz M, Lucia D, Loss G. Surgical Categorization Improve Outcomes and Organ Utilization in Liver Transplant [abstract]. https://atcmeetingabstracts.com/abstract/surgical-categorization-improve-outcomes-and-organ-utilization-in-liver-transplant/. Accessed November 22, 2024.

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