Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Date & Time: None. Available on demand.
*Purpose: There is national variation in acceptance criteria and utilization of livers across transplant centers. Data pertaining to outcomes of liver grafts declined by local and regional centers that go on to be placed nationally remains limited.
*Methods: We assessed 617 liver transplants (LT) at our center spanning the years of 2015 through June 2020. Multivisceral and living donor LT were excluded.
*Results: During this period, 109 (17.7%) nationally allocated liver allografts were used compared to 508 (82.3%) from local and regional donors. Recipients of nationally allocated livers had lower Model for End Stage Liver Disease (MELD) scores (18.2± 7.1 vs. 22.8±8.6, p<0.0001). A higher percentage of nationally allocated livers came as post-cross clamp offers (29.4% vs. 13.4%, p<0.0001); 14.7% came from donation after cardiac death donors (p=0.18). Cold ischemia time (CIT) was higher for national offers (7.9±1.9 vs. 5.8±1.7, p<0.0001) and a local recovery surgeon was more often utilized (66.1% vs. 38.6%, p<0.0001). There were no differences in hospital length of stay (p=0.89). Early allograft dysfunction (AST>2000) was more common in nationally allocated grafts (p<0.0001) however there were no differences in the rate of primary nonfunction (1.8% vs. 0.6%, p=0.19). There were no differences in patient (HR 1.07, 95% CI 0.44-2.57, p=0.88) or graft (HR 0.78, 95% CI 0.48-1.28, p=0.35) survival.
*Conclusions: Despite longer CIT and geographic challenges, outcomes from nationally allocated liver allografts are excellent and comparable to those seen from local and regional donors.
|National n=109||Local-Regional n=508||P value|
|ICU LOS, median (days)||1.0||1.0||0.10|
|Hospital LOS, median (days)||5.0||6.0||0.89|
|Day 7 T. Bili >10 (mg/dL)||5 (4.6%)||26 (5.1%)||0.82|
|Day 7 INR >1.6||4 (3.7%)||17 (3.4%)||0.87|
|AST >2000 (U/L) first week||58 (53.2%)||258 (25.2%)||<0.0001|
|Peak AST (U/L)||2974±2341||2969±2439||0.99|
|PNF||2 (1.8%)||3 (0.6%)||0.19|
To cite this abstract in AMA style:Ohara S, Lizaola-Mayo B, Morgan P, Das D, Wagler J, Reddy KS, Aqel B, Moss A, Jadlowiec C. Liver Transplant Outcomes Using Nationally Allocated Grafts [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplant-outcomes-using-nationally-allocated-grafts/. Accessed September 19, 2021.
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