Background: Pre-recovery liver biopsy (PLB) has potential to decrease costs of futile liver recovery and increase recovered utilization, therefore we examined its safety, feasibility, and organ yield.

Methods: Using Case Control design, 22 consecutive PLB performed in brain death (BD) donors from 01/01/00 to 10/01/12 were matched to 44 Controls (immediately before and after cases). Demographic, hemodynamic, laboratory, logistic and transplantation (LT) data were obtained from OPO records. Complication consisted as composite of hemoglobin drop > 2 g/transfusion < 24hrs/ MAP drop > 20mmHg. Primary outcomes were observed/expected LT (O/E) and O minus E/100 donors utilizing UNOS yield calculator public beta v1 for donors in whom liver recovery was attempted. Direct costs of liver recovery were considered $7,000. Statistics were performed with JMP-10 (SAS Institute Inc, NC). Differences between proportions and continuous data (medians) were tested with Fisher’s and Wilcoxon tests, respectively.

Results: Cases were older (54 vs. 45 yrs), had higher BMI (30.2 vs. 25.4), more hypertension (81 vs. 42%) and alcohol abuse [57 vs. 23%; all, p<0.05]. There were no significant differences in race, sex, diabetes, drug use, liver disease, hemodynamic or laboratory parameters. Reasons for PLB comprised alcohol abuse (45%), obesity and/or diabetes (32%), advanced age (14%) and hepatitis serologies (9%). Interval from BD declaration to organ procurement was significantly longer in cases (24.3 vs. 14.3 hrs, p < 0.05). Complications were similar (9 vs. 18%).

In 7/22 cases liver procurement was not attempted based on PLB. In 1 donor hemodynamic instability led to no organ recovery. 12/14 livers were transplanted. The PLB led to aggregate cost savings of $35,000 ($49,000 minus 14,000). In 4/44 controls liver procurement was medically ruled out. In 2 donors hemodynamic instability led to no organ recovery. 32/38 livers were transplanted. Discarding 6/44 livers incurred costs of $42,000. The table shows O/E, O minus E/100 and odds ratios. O minus E/100 was significantly higher in cases (p < 0.05).

Conclusions: In "marginal" BD liver donors our data suggests PLB is safe and may save costs of futile liver recovery. Preliminary trends towards improved liver utilization in PLB donors need corroboration in larger studies.

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