Evaluation of Increasing Liver Discard Rate and Waiting List Drop-Off in Post-MELD Era

R. Matsumoto¹, K. Halazun², J. Emond¹, B. Samstein², R. S. Brown Jr.², L. Dove¹, T. Kato¹

¹Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY, ²Center for Liver Disease and Transplantation, Weill Cornell Medical Center, New York, NY

Meeting: 2021 American Transplant Congress

Abstract number: 1154

Keywords: Donors, marginal, Liver transplantation, Mortality, Waiting lists

Topic: Clinical Science » Liver » Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Information

Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: As number of donors and transplant cases rises each year, it is important to evaluate not only post-transplant survival rate but also the organ utilization rate and the waiting-list mortality. In addition, it is known that current regulatory criteria could potentially encourage risk-averse behavior by transplant centers and could affect the organ utilization rate.

*Methods: Adult post-liver transplant (LT) survivals, intention-to-treat (ITT) survivals, DRI (Donor Risk Index), waiting-list (WL) drop-off rates and organ discard rates were studied in the post-MELD era using the Scientific Registry Transplant Recipients (SRTR) database and Stata software. We divided the era in five different cohorts (C1: 2002-2006, C2: 2007-2009, C3: 2010-2012, C4: 2013-2015, C5: 2016-2018). We calculated the organ discard rate as total number of cases in which organs were not used for transplant divided by total number of cases that were authorized to donation. We also defined the incidence of waitlist removal due to death and condition deterioration as the WL drop-off rate.

*Results: The discard rate was significantly higher in the most recent cohort compared to other cohorts (p<0.05) in spite of DRI being stable for the past 10 years. The number of discard organ (discard rate) was 6068 (24.88%), 6536 (24.9%) and 8028 (25.74%) in C3, C4 and C5, respectively. The mean DRI for entire donors was 1.360, 1.3631,1.367, whereas DRI for discarded organ was 1.439,1.441, 1.447 in C3, C4 and C5, respectively (p>0.1). From early to recent years, the LT survival has been significantly improving. The 1-year post-LT survival was 77.04%, 80.99%, 83.4%, 87.15%, 88.72% in C1, C2, C3, C4, and C5 respectively. However, there was a significant increase in WL drop-off rate in recent cohorts. (24.69 vs 29.5 vs 32.14 vs 32.69 vs 37.78 100 person-years.) Moreover, there was no significant improvement in ITT survival. One-year ITT survival was 70.29%, 70.30%, 68.15%, 69.52%, and 70.76% in C1, C2, C3, C4, and C5 respectively.

*Conclusions: Although post-liver transplant survival rate has been improving significantly, WL drop-off rate has been increasing. In addition, despite the DRI for discarded organs being stable throughout the past 10 years, the discard rate has been rising. These outcomes may be the result of centers avoiding high-risk transplants aiming to increase the post-transplant survival. The effect of new liver allocation policy has yet to be determined.

To cite this abstract in AMA style:

Matsumoto R, Halazun K, Emond J, Samstein B, Jr RSBrown, Dove L, Kato T. Evaluation of Increasing Liver Discard Rate and Waiting List Drop-Off in Post-MELD Era [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-increasing-liver-discard-rate-and-waiting-list-drop-off-in-post-meld-era/. Accessed May 9, 2025.

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