Predicting Liver Allograft Discard

Rana, Abbas; Sigireddi, Rohini R.; Halazun, Karim J.; Kothare, Aishwarya; Wu, Meng-Fen; Líu, Hao; Kueht, Michael; Vierling, John M.; Sussman, Norman; Mindikoğlu, Ayşe L.; Miloh, Tamir; Galván, Nhu Thao Nguyen; Cotton, Ronald T.; O’Mahony, Christine A.; Goss, John A.

doi:10.1097/tp.0000000000002151

Cited by 31 publications

(69 citation statements)

References 23 publications

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“…In addition, more programs have begun using NaS allografts (69 vs 77 programs overall, 8 vs 20 programs with significant NaS allograft use in 2002‐2006 vs 2012‐2016). Using the metric of the Discard Risk Index, the NaS allografts have decreased in quality over time. Potentially offsetting this reduction in allograft quality, cold ischemia time has significantly decreased (10.4 hours vs 8.0 hours, P < .001).…”

Section: Resultsmentioning

confidence: 99%

“…Optimizing utilization of eligible donors will provide an immediately accessible source of donors. In 2016, 20% of donor liver were discarded at the time of procurement, representing 1600 potential allografts . An essential aspect to optimizing utilization of eligible donors is to understand aggressive acceptance of marginal allografts and to elucidate practices where benchmark outcomes are achieved .…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, 20% of liver allografts were not used for transplantation after a donor was taken to the operating suite with the intent to procure a solid organ for transplantation . More aggressive acceptance of marginal liver allografts would reduce this discard rate.…”

Section: Introductionmentioning

confidence: 99%

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A learning curve in using orphan liver allografts for transplantation

Rana

Joshi

Price

et al. 2020

Clinical Transplantation

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A learning curve in using orphan liver allografts for transplantation

Rana

Joshi

Price

et al. 2020

Clinical Transplantation

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“…Various ranges of donor GGT, along with donor and recipient risk factors listed above, were adjusted for in a multivariate Cox regression analysis with graft failure over time as the dependent variable. 8,11,15 Reference levels were based on clinical judgments.…”

Section: Methodsmentioning

confidence: 99%

Donor Gamma-Glutamyl Transferase Is Associated With Liver Allograft Discard and Failure

et al. 2021

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Introduction: The disparity between the number of individuals on the wait list and available liver allografts creates the need for a system that maximizes donor liver utilization and predicts graft failure. Research Question: This study aimed to determine the relationship between donor Gamma-Glutamyl Transferase (GGT), liver discard, and graft failure. Design: Through multivariate analysis from 53 966 deceased liver donors, we adjusted for donor clinical and demographic characteristics and compared donor GGT with allograft discard. We compared donor GGT ranges with graft failure and analyzed data from 47 269 liver recipients. Results: After adjusting for other factors, donor GGT was significantly associated with liver discard, with GGT over 200 U/L being most significant (OR 2.74, CI 2.51-2.99). Donor GGT under 20 U/L was also found to be a protective factor for post-transplant graft failure (HR 0.91, CI 0.83 – 1.00). Conclusion: Going forward, GGT should be included among other characteristics associated with allograft discard considered during the procurement process.

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“…Previous studies have shown that only 36.7% of discarded livers are even assigned a formal reason for discard. ( 5 ) Although the UNOS has long tracked overall organ acceptance rates, there are few data on the frequency of declines that occur after the start of procurement, geographic and transplant center variability, the impact of intraoperative decline, or possible strategies to improve utilization of these organs.…”

mentioning

confidence: 99%

Understanding the Final Disposition of Livers Declined After the Start of Procurement: A Nationwide Organ Procurement Organization Effort

Neidlinger

Brown²,

Wood³

et al. 2021

Liver Transpl.

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Declining a liver offer during organ procurement likely increases the risk of discard, but the specifics around late reallocation remain obscure. This voluntarily submitted, prospectively collected data describe late declines and the ultimate disposition of 893 livers. Once a liver suffered an intraoperative decline, only 49% of recovered livers were transplanted. Livers declined ≥80 minutes prior to cross‐clamp were transplanted 80% of the time versus livers declined ≥80 minutes after cross‐clamp, which were transplanted 45% of the time. The final disposition of these livers was into a predetermined backup patient (51%) or required an out‐of‐sequence expedited allocation (42%). Prerecovery imaging and prerecovery biopsy did not influence the ability to reallocate a liver, and livers from donors after circulatory death are rarely successfully reallocated. In conclusion, this study begins to shed light on this seemingly common practice. A total of 85% of centers had an intraoperative decline, but 4% of centers accounted for 25% of the declines. Organ procurement organizations often enter expedited liver allocation, and instituting a cross‐clamp delay to allow for reallocation may influence the disposition of these liver grafts. Expedited allocation was more time consuming than allocation into a predetermined backup. Although a certain number of intraoperative declines probably suggests a healthy amount of donor selection aggressiveness at the time of the initial organ offer, the 47% risk of discard of livers declined intraoperatively suggests that United Network for Organ Sharing should consider systematically collecting data about intraoperative declines so we can learn more about this event that influences organ utilization.

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Predicting Liver Allograft Discard

Abstract: The use of the DSRI can help predict liver allograft discard. The DSRI can be used to effectively grade allografts and preferentially allocate marginal allografts to aggressive centers to maximize the donor yield and expedite allocation.

Cited by 31 publications

References 23 publications

A learning curve in using orphan liver allografts for transplantation

A learning curve in using orphan liver allografts for transplantation

Donor Gamma-Glutamyl Transferase Is Associated With Liver Allograft Discard and Failure

Understanding the Final Disposition of Livers Declined After the Start of Procurement: A Nationwide Organ Procurement Organization Effort

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