UTILIZATION OF EXTENDED DONOR CRITERIA LIVER ALLOGRAFT: IS THE ELEVATED RISK OF FAILURE INDEPENDENT OF THE MELD SCORE OF THE RECIPIENT?Room: Ballroom A
Daniel G Maluf, Erick Edwards, Myron Kauffman. Surgery, Virginia Commonwealth University, Richmond, VA; UNOS, United Network for Organ Sharing, Richmond, VA.
Background: Utilization of liver allografts from extended criteria donors ( ECD) offers immediate expansion of the donor pool. The goal of this analysis was to determine if outcomes from the use of ECD livers differed according to the MELD score of the recipient.
Methods: Donor and recipient data from the OPTN database as of 3/4/06 were used for the analysis. A standard MELD group (N=9258) and a hepatocellular carcinoma (HCC) group (N=2798) of adult liver recipients transplanted between 6/1/2002 and 6/30/2005 were analyzed separately. Repeat transplants, recipients of partial or split livers, multiorgan transplants, pediatric transplants (<18yo) and MELD exceptions (non-HCC) were excluded. The SRTR donor risk index (DRI) was calculated as described in the report by Feng et al (2006). A DRI of >=1.7 was classified as ECD. Relative risk (RR) estimates were derived from Cox regression models adjusted for DRI, recipient MELD, age, gender, ethnicity, diagnosis, and year of transplant.
Results. Data from12,056 liver recipients were analyzed with 2944 grafts coming from donors falling in the ECD category (24.41%). Of the standard MELD recipients group, most patients were Caucasian (77%) and male (67%). Recipients with low MELD scores (<15) received the highest proportion of ECD livers during the period (34%) compared to 25% (15 - 26) and 19% (MELD >27) for the other groups. ECD livers were associated with a significant increase in the risk of graft failure within each recipient MELD score category: MELD <15, RR:1.62 (p <0.001), MELD 15-26, RR 1.75 (p <0.001) and MELD >26, RR 1.44 (p< 0.001). The relative risk varied with MELD score, but was not statistically different among the categories. A similar effect was seen in HCC recipients of ECD livers, without a statistically significant difference among the MELD score categories.
Conclusion: The use of liver allografts that do not meet traditional donor criteria offers immediate expansion of the donor pool at the expense of an increased risk of graft failure following transplant. While the increased relative risk was not statistically different among the recipient MELD categories, the highest relative risk was observed in recipients with MELD scores in the 15-26 range. The least impact of ECD livers was observed in recipients with MELD >26 and seems to be the group that could benefit most from this pool of grafts.
Keywords: Donors, marginal; Liver transplantation; Outcome
Wednesday, July 26, 2006 4:10 PM
Concurrent Session 84: Allocation and Outcome with ECD and SPLIT Liver Grafts (4:00 PM-6:00 PM)