he deficit of donor livers for transplant in the United States is growing. In 2000, there were 12 000 more patients on the liver transplant waiting list than the number of patients who actually received liver allografts. 1 At present, half of the patients awaiting liver transplant will not receive an allograft. 2 In 2016, more than 20% of liver allografts from deceased donors intended to be transplanted were discarded. 3 These discarded allografts are the most accessible source of organs to bridge this unmet need. More aggressive use of these allografts will tap into this existing source of donors and holds the most promise for increasing the chance for transplantation for patients awaiting transplant and decreasing death while on the waiting list.In 2016, approximately 1600 liver allografts 3 were discarded. Reduction of this discard rate could be accomplished by more aggressive transplant of "marginal" allografts, as they are defined today. These marginal allografts historically demonstrated worse allograft and patient outcomes compared with nonmarginal allografts. Comprehensive center-level studies indicate that wider acceptance of marginal allografts bolsters donor supply and, more importantly, reduces waiting list mortality. 4 More zealous use of marginal allografts is associated with increasing transplant center volume, possibly owing to the widening chasm between the number of patients on the waiting list and available allografts. [5][6][7][8] Use of marginal allografts has been shown to demonstrate similar short-term outcomes as nonmarginal allografts while also reducing candidate time on the waiting list. [9][10][11] Investigating outcomes of these marginal allografts is essential to understanding how they can be used most effectively. IMPORTANCE Investigating outcomes after marginal allograft transplant is essential in determining appropriate and more aggressive use of these allografts.OBJECTIVE To determine the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria. DESIGN, SETTING, AND PARTICIPANTSIn this cohort, multicenter study, 75 050 patients who received a liver transplant between March 1, 2002, and September 30, 2016, were retrospectively analyzed to last known follow-up (n = 55 395) or death (n = 19 655) using the United Network for Organ Sharing Database. The study period was divided into three 5-year eras: 2002-2006, 2007-2011, and 2012-2016. Kaplan-Meier survival analysis with log-rank test and Cox proportional hazards regression analysis were used to examine the allograft after transplant with marginal allografts, which were defined as 90th percentile Donor Risk Index allografts (calculated over the entire study period), donor after circulatory death allografts, national share allografts, old age (donors >70 years) allografts, fatty liver allografts, and 90th percentile Discard Risk Index allografts. Statistical analysis was performed from August to December 2019.MAIN OUTCOMES AND MEASURES Allograft failure after transplant as defined by the Org...

In the past several decades, pediatric liver transplantation mortality has continued to decline; this is notable given that the indications for pediatric liver transplantation have broadened and become increasingly complex. 1-3 This reduction in mortality is due in large part to not only new surgical techniques, but also the implementation of standardized scoring systems, such as the PELD and MELD scores, which prioritize patients based on the severity of disease. 4 However, as the field of pediatric transplantation progresses, it becomes increasingly important to include other metrics beyond mortality and address them to mitigate risk factors and improve outcomes. For example, while PELD and MELD scoring systems have led to a drastic decrease in mortality, it has been shown that their implementation has actually led to increased costs and that the score alone is not a perfect predictor of post-transplantation complications. 5-8 Meanwhile, other variables have been shown to be associated with complications following surgery and, in particular, the post-transplant LOS in the hospital. 9-13 Importantly,

Background: Despite noted improvements in short-term survival outcomes following orthotopic heart transplantation (OHT), review of the relevant literature suggests little improvement in long-term outcomes for patients surviving beyond 1 year. Methods: All OHT cases performed between 1989 and 2019 within the United Network for Organ Sharing (UNOS) database were reviewed. Adults who underwent isolated OHT were included in a 1-year survival analysis. Those who survived at least 1 year post-transplant were included in a long-term survival analysis. Demographic factors were assessed using Students' t test and chi-square analysis. Survival trends and risk factors were assessed using the Kaplan-Meier and the Cox regression analysis, respectively.Results: A total of 53 265 and 46 372 recipients were included in the short-term and long-term cohorts, respectively. In an adjusted analysis, the reference implant era 2014-2019 had significantly better short-term survival outcomes when compared

The study of marginal liver transplant outcomes, including post‐transplant length of stay (LOS), is necessary for determining the practicality of their use. 50 155 patients who received transplants from 2012 to 2020 were retrospectively analyzed with data from the Scientific Registry of Transplant Recipients database using Kaplan‐Meier survival curves and multivariable Cox regression. Six different definitions were used to classify an allograft as being marginal: 90th percentile Donor Risk Index (DRI) allografts, donation after cardiac death (DCD) donors, national share donors, donors over 70, donors with > 30% macrovesicular steatosis, or 90th percentile Discard Risk Index donors. 24% (n = 12 124) of subjects received marginal allografts. Average LOS was 15.6 days among those who received standard allografts. Among those who received marginal allografts, LOS was found to be highest in those who received 90th percentile DRI allografts at 15.6 days, and lowest in those who received DCD allografts at 12.7 days. Apart from fatty livers (95% CI .86–.98), marginal allografts were not associated with a prolonged LOS. We conclude that accounting for experience and recipient matching, transplant centers may be more aggressive in their use of extended criteria donors with limited fear of increasing LOS and its associated costs.

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