Do High-Risk Categories Convey the Wrong Message to Waitlisted Patients – Is It Time to Reconsider the Absolute Risk of Graft Loss?
Transplant Surgery, UCSF, San Francisco, CA.
Meeting: 2018 American Transplant Congress
Abstract number: A290
Keywords: Donors, High-risk, Liver transplantation, non-heart-beating, unrelated
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
Many waitlisted patients (pts) do not consent to accept livers from “high-risk” donors (HRD), possibly due to lack of understanding of the absolute risk (AR) involved; we wanted to understand risk of graft loss after deceased donor (DD) liver transplant (LTX) with a HRD liver.
Methods
Retrospective, single center review of 662 DD LTXs (2012-2017). Analyzed 1-year graft survival from 3 HRD categories (HCV+, DCD, age>60). Kaplan-Meier (KM) analyses performed for all HRD sub-groups. PHS HRD were not included.
Results
Of 662 DD LTX performed, 31.9% were from the 3 HRD groups (HCV+=68; DCD=60; age>60=83). Cumulative 1-year graft survival was 94.7% in these 3 HRD groups. Graft loss at 1-year was similar between HCV+ HRD and HCV neg DD, 2.9% vs 2.4%, respectively (p=ns). For HRD age 60-69 (n=53) and >70 (n=30), there were 7 and 3 graft failures, respectively. KM analysis of age<60 compared to 60-69 revealed HR=0.89 (p=0.81), and HR=1.22 (p=0.69) for age>70. In DCD donors (n=60), average DD age was 31 (59 for non-DCD). 3.3% required re-transplant at 1-year. 22% of DCD recipients had anastomotic biliary complications, and 14% non-anastomotic.
Conclusion
HRD categories can be confusing for waitlisted pts. HRD may falsely convey an increased risk of graft loss. The AR of graft loss after LTX using these DD is quite low (94.7% 1-year graft survival), and is comparable to non-HRD. The notable exception is DCD DD due to the risk of ischemic cholangiopathy. Additionally, our data did not include “PHS” HRD due to the very low risk of graft loss related to the PHS classification. Education about the AR of graft loss compared to risk of death on the waiting list is pivotal to ensure informed consent of waitlisted pts, and we should consider removing these confusing DD categories.
CITATION INFORMATION: Zarinsefat A., Braun H., Syed S., Orandi B., Roll G. Do High-Risk Categories Convey the Wrong Message to Waitlisted Patients – Is It Time to Reconsider the Absolute Risk of Graft Loss? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Zarinsefat A, Braun H, Syed S, Orandi B, Roll G. Do High-Risk Categories Convey the Wrong Message to Waitlisted Patients – Is It Time to Reconsider the Absolute Risk of Graft Loss? [abstract]. https://atcmeetingabstracts.com/abstract/do-high-risk-categories-convey-the-wrong-message-to-waitlisted-patients-is-it-time-to-reconsider-the-absolute-risk-of-graft-loss/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress