Background: One organ procurement organization (OPO) sought to study expedited versus non-expedited livers recovered/transplanted after local/regional centers declined. The OPO sought to determine relative recipient MELD scores and recipient post-transplant outcomes.

Method: A review of all deceased donors (DBD and DCD) was conducted for local donors between 01/01/2015 and 12/31/2016 utilizing data obtained from UNOS. Liver recovery, allocation, and transplant data were compared.

Results: The OPO recovered and transplanted 106 (2015) and 105 (2016) livers. There was an increase of livers allocated and transplanted through expedited placement (+87.5 %) in 2016 (n=15) compared to 2015 (n=8). Non-expedited livers declined 8.2% from 2015 (n=98) to 2016 (n=90). Livers expedited and transplanted were used in recipients with an average MELD score of 21 (2015) and 17 (2016). Non-expedited recipients had a higher average MELD score at transplant of 29 both years. Average cold ischemic times for expedited livers were 8.5 (2015) and 7.8 (2016) hrs. vs. 6.9 and 6.5 hrs. respectively for non-expedited livers transplanted. Although the sample size was small, post-transplant outcomes indicate a notably higher recipient mortality rate in 2015 vs 2016 (38% vs. 6.7%) for expedited liver allocation while a decreased mortality in the non-expedited liver allocation (14% vs. 9%) was noted. The rate of re-transplanted recipients increased slightly (0% vs. 6.7%) from 2015 to 2016 in the expedited group and decreased slightly in the non-expedited group (5% to 3%).

Discussion/Conclusions: While overall recovered and transplanted livers remained essentially the same from 2015 to 2016, in 2016 there were more livers transplanted through expedited placement and overall more livers of all types were placed nationally (+150 %). In 2016 there were fewer non-expedited livers transplanted (-8.6%). While the sample size is limited in each year, we conclude that in this OPO's experience transplant centers appear to select recipients with a lower MELD score for expedited livers vs. non-expedited. Finally, when comparing expedited livers to non-expedited, the data show essentially identical rates of re–transplantation (5.6% vs. 5.1%) and increased rates of perioperative death (22.2% vs 13.9%). We recommend further study related both to utilization and outcomes of expedited vs. non-expedited livers, and use of expedited livers in recipients with lower MELD scores at time of transplant.

CITATION INFORMATION: Muse C., Squires R., Trahan C., Whaley J., Orlowski J. Liver Allocation: One OPO's Experience with Expedited versus Non-Expedited Placement Am J Transplant. 2017;17 (suppl 3).

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