Background: Each year in the US, 450-500 livers are discarded as unacceptable for transplant. Currently, there is controversy about the implications of broader sharing and longer ischemic times. The most common reasons are high donor risk index (DRI) and/or donor quality, biopsy results and donor age. In this study we present our results with imported compared to locally procured livers.

Methods: Liver grafts offered to our center after being refused locally were reviewed by a transplant surgeon. Decisions to use the organ were based upon UNET donor information, biopsy and pre and post-flush graft photo documentation. In some cases, personal communication with recovery surgeon aided in the decision. Acceptable grafts were then matched with appropriate recipients.

Results: Between 2009 and March 2015, 252 deceased donor (DD) liver transplants (LTx) were performed at a single center; 178 were procured locally, 74 were imported grafts. 81% of imports were transplanted into non-HCC candidates vs. 55% of local grafts (p=.002). Grafts were obtained from 9/11 UNOS regions. Mean transit time = 185 minutes for imports including air transit, and 215 for local (drive time). Transit time comprised 36.8% of CIT for imports and 47.6% of CIT for local grafts (p=.003). Data presented as means, significance p<0.05 by Student's t-test. Graft survival calculated by Kaplan-Meier method.

Conclusions: Imported “unwanted”, higher DRI liver grafts can be used in selected patients with similar outcome to livers procured locally. Concerns about broader sharing relative to ischemic/travel times are not supported in this study. Use of import livers may mitigate wait-list mortality for non-HCC recipients.

CITATION INFORMATION: Akoad M, Simpson M, Pomposelli J, Pomfret E. Good Livers with a Bad Reputation: Favorable Outcome with Imported Grafts. Am J Transplant. 2016;16 (suppl 3).

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