Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*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.
|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|
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 August 8, 2020.
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