21. Utilization Of Extended Donor Criteria Liver Allografts Maximizes Donor Utility and Patient Access To Liver Transplantation
John Renz, MD PhD*, Cindy Kin, MD*, Milan Kinkhabwala, MD*, Dominique Jan, MD*, Rhagu Varadarajan, MD*, Michael Goldstein, MD*, Robert Brown, Jr., MD MPH*, Jean C. Emond, MD
New York Presbyterian Hospital, New York, NY
OBJECTIVE: Utilization of liver allografts that do not meet traditional donor criteria (EDC) offer immediate expansion of the donor pool. EDC are typically allocated by transplant center rather than wait-list priority (UNOS). This study evaluates systematic application of EDC, including living-donor allografts (LD), on patient access to LTX.
METHODS: Retrospective analysis of 99 EDC recipients (49 cadaver, 50 LD) and 128 UNOS recipients from 04/01 through 04/04. Cadaver-EDC included: age>65yr, donation after cardiac death, viral serology (hepatitis C [HCV], human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, and complication categorized as: biliary, vascular, wound, and delayed or primary graft nonfunction.
RESULTS: EDC recipients were more frequently diagnosed with HCV or hepatoma and had a lower model for end stage liver disease (MELD) score at LTX (p<0.01vsUNOS). Wait-time, technical complications, and hospitalization were comparable. Log-Rank analysis of Kaplan-Meier survival estimates demonstrated no difference in patient or graft survival; however, deaths among cadaver-EDC recipients were principally the result of patient co-morbidities while LD and UNOS deaths resulted from graft failure (p<0.01) EDC increased patient access to LTX by 77% and reduced pre-LTX mortality by over 50% compared to regional data (p<0.01).
CONCLUSION: Systematic EDC utilization maximizes donor utility, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.
| PARAMETER | EDC | LD | UNOS | p |
| MELD(S.D.) | 22(11) | 16(5) | 25(12) | <0.01 |
| WAIT-TIME(S.D.) | 188(218) | 265(296) | 222(300) | NS |
| HOSPITALIZATION(S.D) (days) | 22(26) | 14(9) | 27(31) | NS |
| KAPLAN-MEIER 1 MONTH GRAFT (%) | 88 | 95 | 94 | NS |
| KAPLAN-MEIER 1 YEAR GRAFT (%) | 80 | 85 | 82 | NS |
| KAPLAN-MEIER 2 YEAR GRAFT (%) | 74 | 82 | 77 | NS |
| KAPLAN-MEIER 1 MONTH PATIENT (%) | 89 | 100 | 94 | NS |
| KAPLAN-MEIER 1 YEAR PATIENT (%) | 80 | 89 | 84 | NS |
| KAPLAN-MEIER 2 YEAR PATIENT (%) | 76 | 87 | 79 | NS |