Traditionally Unacceptable Organs Promote Liver Transplantation in Patients with Long Waiting Times in the Share 35 Era.

E. Siskind,¹ T. MacDonald,² R. Barth,¹ J. LaMattina,¹ D. Bruno,¹ S. Hanish.¹

¹Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
²University of Maryland Medical Center, Baltimore, MD.

Meeting: 2016 American Transplant Congress

Abstract number: 106

Keywords: Allocation, Hepatocellular carcinoma, High-risk

Session Information

Session Name: Concurrent Session: Hepatic Malignancies

Session Type: Concurrent Session

Date: Sunday, June 12, 2016

Session Time: 4:30pm-6:00pm

Presentation Time: 4:54pm-5:06pm

Location: Room 304

Hepatocellular carcinoma (HCC) remains the most commonly granted MELD exception (M/E). Share 35 has disadvantaged this population. We have developed a strategy to use traditionally unacceptable organs (TUOs) including locally discarded organs, grafts with macrosteatosis, and DCD donors for these recipients.

Methods:

A retrospective review of the patients transplanted for HCC in a large urban academic medical center was performed from 1/2012-8/2015. Recipient and Donor data were obtained from our databases. Longitudinal follow-up has been maintained for recurrence of HCC. M/E at transplant, time to transplant, donor origin and organ type were analyzed.

Results:

In 2012, 30% of patients were transplanted under an HCC M/E. They had an average waitlist time of 435 days and 85% of the grafts were from local donors. After Share 35, the HCC M/E patients made up only 20% of the transplanted population with most of livers (85%) procured locally. This decreased to 15% with concomitant increase in the time to transplant. In 2015, with the use of TUOs for the HCC population we observed an increase in the percentage of M/E (30%) patients transplanted with a decrease in transplant time (213 days v. 311days, p=0.001). Regionally procured livers increased to 50% for the HCC M/E population. There was no change in the average MELD at transplant in the time periods analyzed (p=0.2).

Conclusion:

Liver transplantation in the Share 35 era disadvantages the HCC M/E population. An aggressive approach to the use of local and regional TUOs may increase in the number of M/E patients transplanted. This may lead to a reduction in waitlist time and a reduction in early disease recurrence.

Year	N=Liver Transplant for HCC	Ave. MELD at Transplant (p=0.2)	Ave. Wait time (days) p=0.001)	Import Livers (%)
2012	26	24.6	435	4(15%)
2013	17	26.2	262	3(18%)
2014	17	27.5	311	4(23%)
2015	28	27.2	213	14(50%)

CITATION INFORMATION: Siskind E, MacDonald T, Barth R, LaMattina J, Bruno D, Hanish S. Traditionally Unacceptable Organs Promote Liver Transplantation in Patients with Long Waiting Times in the Share 35 Era. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Siskind E, MacDonald T, Barth R, LaMattina J, Bruno D, Hanish S. Traditionally Unacceptable Organs Promote Liver Transplantation in Patients with Long Waiting Times in the Share 35 Era. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/traditionally-unacceptable-organs-promote-liver-transplantation-in-patients-with-long-waiting-times-in-the-share-35-era/. Accessed May 11, 2025.

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