*Purpose: Significant hepatic injury and impairments in biliary excretion manifest serologically in elevated bilirubin levels. Despite a direct linkage between hyperbilirubinemia and hepatobiliary dysfunction, significance of donor hyperbilirubinemia on post-transplant liver allograft function has not been clearly defined. We sought to ascertain any impact of donor hyperbilirubinemia on graft outcomes in the modern era.

*Methods: Retrospective review of the Organ Procurement and Transplantation Network database was performed for 62,604 adult non-status 1A liver transplant recipients from 2002 to 2019. Kaplan-Meier curves assessed survival using a bilirubin of 2 mg/dL as a cutoff. Propensity matching (PSM) controlled for confounding variables across cohorts.

*Results: Univariate analysis of graft and patient survival demonstrated no difference in donors with bilirubin > 2 mg/dL compared to control (HR = 1.019, p=0.535). After controlling for confounding variables using PSM, both graft and patient survival at 1, 3, and 5 years was similar across groups. Furthermore, incidence of primary non-function was quite low and similar at 0.51% and 0.63% in the low and high bilirubin groups, respectively (p=0.451).

*Conclusions: In a large database analysis, we found that elevated bilirubin levels do not predict graft or patient outcomes. While more in-depth donor analysis using organ procurement organization data would help elucidate a more precise safety profile, transplant providers with careful scrutiny of donor and recipient pairs should continue to use deceased donor livers with elevated bilirubin.

« Back to 2020 American Transplant Congress