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 Fishers 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).
|Recovery Attempted||Observed Yield||Expected Yield||O/E||O minus E / 100||Odds Ratio|
|Controls (n=38)||32||30.9||1.04||+2.9*||0.76 (0.28, 2.07)|
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.
To cite this abstract in AMA style:Oliver J, Bongu A, Koneru B. Pre-Recovery Liver Biopsy in Brain Death Donors – Case Control Study of Safety, Feasibility and Liver Utilization [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/pre-recovery-liver-biopsy-in-brain-death-donors-case-control-study-of-safety-feasibility-and-liver-utilization/. Accessed June 14, 2021.
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