Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Date & Time: None. Available on demand.
*Purpose: The purpose of this study was to determine the effect on recipient length of hospital stay following transplantation with marginal allografts as specified by 6 different definitions.
*Methods: 50,155 patients who received transplants from 2012 to 2020 were retrospectively analyzed through hospital discharge in this multi-center cohort study using the United Network for Organ Sharing database. Length of stay was defined as the time from transplant to discharge and was analyzed using Kaplan-Meier survival curves and multivariable Cox regression. Six different definitions were used to classify an allograft as being “marginal”: 90th percentile Donor Risk Index allografts, Donation after Cardiac Death donors, national share donors, donors over 70, donors with >30% macrovesicular steatosis, or 90th percentile Discard Risk Index donors. Standard criteria donors were defined as not meeting any of these definitions.
*Results: Of the 50,155 patients who received liver transplantation from 2012-2020, 24% (n=12,124) received organs that were classified as marginal. Recipients of marginal allografts had significantly lower laboratory Model for End-stage Liver Disease (MELD) scores with an average of 19.9 compared to 23.3 for recipients of standard allografts (p < 0.001). The use of allografts from Donation after Cardiac Death donors, national share donors, 90th percentile Donor Risk Index donors, 90th percentile Discard Risk Index donors, and donors older than 70 did not lead to a prolonged length of stay. However, the use of fatty liver allografts (macrovesicular steatosis >30%) was associated with a prolonged length of stay (hazard ratio, 0.93 [95% CI, 0.87 – 0.99]) (hazard ratio > 1 associated with earlier discharge). Cold ischemia time was associated with a shortened length of stay when less than 6 hours (hazard ratio, 1.09 [95% CI, 1.07 – 1.11]) and increased length of stay when greater than 12 hours (hazard ratio, 0.82 [95% CI, 0.76 – 0.89]).
*Conclusions: Liver transplant centers can be more aggressive in their use of extended criteria donors with limited fear of increasing length of stay and its associated healthcare costs.
To cite this abstract in AMA style:Goff C, Zhang T, McDonald M, Anand A, Galvan N, Kanwal F, Cholankeril G, Hernaez R, Goss JA, Rana A. Marginal Allografts in Liver Transplantation Have Very Limited Impact on Length of Stay [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/marginal-allografts-in-liver-transplantation-have-very-limited-impact-on-length-of-stay/. Accessed September 19, 2021.
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