Introduction

Improved utilization of expanded criteria donor (ECD) allografts offers an opportunity to expand the donor pool, reduce wait-times and waitlist mortality. We analyzed outcomes at our center using UNOS match sequence number (MSN) as a proxy for perceived donor allograft quality, with high MSN allocation implying declined offer to recipients at multiple transplant centers. Methods We performed a single center retrospective review of liver transplants at our center from Jan 2012-Dec 2016 (N=748). The MSN, obtained from the match run for each donor, ranged from 1-7558 and was divided into quartiles. The 4^th quartile (MSN 61-7558, median 683, N=187) was defined as the High MSN group (hMSN) and quartiles 1-3 as control group (MSN 1-60, median 5, N=561). Primary outcomes were patient and graft survival and early graft dysfunction (EAD) defined by peak AST or ALT >2000 or bilirubin day 7 >10 or INR day 7 >2.0. Results Compared with the control group, a higher proportion of livers in the hMSN group were national allocation (96.3% vs 36.2%, P=<0.0001). Recipients in the hMSN group had lower median calculated MELD at transplant (16 vs 21, P=<0.001). There were no significant differences in patient survival (91.2 vs 87.3; p=0.4) or allograft survival (85.1 vs 88.5 p=0.5, log-rank) between the control and High MSN groups at 3 years with median follow-up of 1031 days. There was no significant difference in graft survival between local, regional and national share livers (p=0.6). Higher rate of EAD was observed in the hMSN group compared to control (36.3% vs. 20.8%, OR 2.2, p<0.001), and in livers from regional/national allocation compared to local allocation (64.5% vs. 35.5%, OR 1.94, p<0.0001). There was no significant difference in median POD7 AST (50 vs 42, p= 0.09), ALT (141.5 vs 131, p=0.05) or INR (1.1 vs 1.1, p=0.8) between the control and hMSN groups. Total bilirubin was higher in the hMSN group on POD 7 (2.4 vs 2.1, p=0.013) and POD30 (1.5 vs 1.4, p=0.02), but no significant difference in biliary complications (24.1% vs 24.8%, p=0.9). Conclusion Using appropriate recipient selection and careful donor allograft assessment, outcomes from utilization of liver allografts allocated at high match sequence numbers are comparable to standard donors. Although a higher rate of EAD was observed in the hMSN group, graft and patient survival were not adversely affected.

CITATION INFORMATION: Park M., De Gregorio L., Bohorquez H., Bruce D., Bugeaud E., Carmody I., Cohen A., Mathur A., Sonnier D., Seal J., Loss G. Outcomes of Livers Allocated to High UNOS Match Sequence Number Recipients at a High Volume Transplant Center Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress