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Liver Transplant Outcomes in Deceased Donors with Elevated Bilirubin: A Large Database Analysis

P. J. Altshuler, A. Rios Diaz, O. Shaheen, A. P. Shah, W. R. Maley, A. Frank, J. Glorioso, C. Ramirez, H. Dang, A. S. Bodzin

Department of Surgery, Thomas Jefferson University, Philadelphia, PA

Meeting: 2020 American Transplant Congress

Abstract number: A-122

Keywords: Donors, marginal, Graft survival, Multivariate analysis, Risk factors

Session Information

Date: Saturday, May 30, 2020

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

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

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*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.

Propensity Matched Baseline, Patient and Graft Survival by Donor Bilirubin
Outcomes Bilirubin <2mg/dL Bilirubin >2mg/dL p-value
Survival: 1 year 4593 (90.75%) 5418 (90.53%) 0.694
3 years 4301 (84.98%) 5058 (84.51%) 0.507
5 years 4101 (81.03%) 4824 (80.60%) 0.577
Graft Survival: 1 year 4490 (88.72%) 5247 (87.67%) 0.091
3 year 4175 (82.49%) 4854 (81.19%) 0.060
5 years 3970 (78.44%) 4626 (77.29%) 0.148
Graft Primary Non-Function 26 (0.51%) 38 (0.63%) 0.451

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To cite this abstract in AMA style:

Altshuler PJ, Diaz ARios, Shaheen O, Shah AP, Maley WR, Frank A, Glorioso J, Ramirez C, Dang H, Bodzin AS. Liver Transplant Outcomes in Deceased Donors with Elevated Bilirubin: A Large Database Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplant-outcomes-in-deceased-donors-with-elevated-bilirubin-a-large-database-analysis/. Accessed January 26, 2021.

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