Date: Tuesday, May 5, 2015
Session Name: Concurrent Session: Liver Transplant Allocation Policy
Session Time: 4:00pm-5:30pm
Presentation Time: 5:12pm-5:24pm
Location: Room 122-AB
Objectives: 1) Evaluate liver allograft availability, utilization, and failure probability utilizing the liver donor risk index(LDRI) 2) Correlate allograft utilization with waitlist mortality and incidence of early allograft failure.
Methods: A Scientific Registry of Transplant Recipients search of US adult, initial liver-only transplant, from 01/01/03 through 12/31/13 identified 44686 transplants from 75, 516 consented donors. Allograft origin (local [LCL], regional [RGN], or national [NTL]), LDRI, mechanism of donation (DBD or DCD), waitlist mortality, and emergent relisting for early allograft failure were evaluated.
Results: Consented DBD and DCD donors increased 15% and 391%, respectively; however, transplanted allografts increased by only 9% for DBD and 196% for DCD (p<0.01). The probability of consented DBD or DCD donors yielding a transplant each declined to a low of 82% and 27%, respectively. Overall DRI fell for both DBD (2%) and DCD (11%) despite changing demographics that inflate DRI (p<0.05). LCL utilization increased while NTL significantly declined. LCL and RGN median LDRI were not significantly different over the study period while NTL median LDRI significantly decreased (p<0.05). Waitlist mortality has not improved while the incidence of emergent retransplantation for early allograft failure is a decade low 0.8%.
Conclusion: Increases in consent have not yielded equivalent increases in transplant activity or decreased waitlist mortality. Lower utilization of high-risk allografts and a very low incidence of early allograft failure imply current donor acceptance practices are inadequate to extract the full potential of the existing donor pool and reduce waitlist deaths.
To cite this abstract in AMA style:Renz J, Diaz G, Ratner L, Yersiz H, Millis M, Matthews J. Liver Allograft Utilization Within the United States: 2003-2013 [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-allograft-utilization-within-the-united-states-2003-2013/. Accessed May 25, 2019.
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