Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation

John F. Renz, Cindy Kin, Milan Kinkhabwala, Dominique Jan, Rhaghu Varadarajan, Michael Goldstein, Robert Brown, Jean C. Emond, Christoph Broelsch, Nancy L. Ascher, Byers Wendell Shaw Jr

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Objective: The objective of this study was to evaluate the effect of systematic utilization of extended donor criteria liver allografts (EDC), including living donor allografts (LDLT), on patient access to liver transplantation (LTX). Summary Background Data: 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 regional wait-list priority (RA). This single-institution series compares outcomes of EDC and RA allocation to determine the impact of EDC utilization on donor use and patient access to LTX. Methods: The authors conducted a retrospective analysis of 99 EDC recipients (49 deceased donor, 50 LDLT) and 116 RA recipients from April 2001 through April 2004. Deceased-donor EDC included: age >65 years, donation after cardiac death, positive viral serology (hepatitis C, hepatitis B core antibody, human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, initial graft function, and complication categorized as: biliary, vascular, wound, and other. Results: EDC recipients were more frequently diagnosed with hepatitis C virus or hepatocellular carcinoma and had a lower model for end-stage liver disease (MELD) score at LTX (P < 0.01). 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 deceased-donor EDC recipients were frequently the result of patient comorbidities, whereas LDLT and RA 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 with regional data (P < 0.01). Conclusion: Systematic EDC utilization maximizes donor use, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.

Original languageEnglish (US)
Pages (from-to)556-565
Number of pages10
JournalAnnals of surgery
Volume242
Issue number4
DOIs
StatePublished - Oct 1 2005

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Liver Transplantation
Allografts
Tissue Donors
Liver
Living Donors
Graft Survival
Transplants
Hospitalization
Hypernatremia
Hepatitis B Antibodies
End Stage Liver Disease
Mortality
Kaplan-Meier Estimate
Serology
Hepatitis C
Hepacivirus
Blood Vessels
Comorbidity
Hepatocellular Carcinoma
Carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Renz, J. F., Kin, C., Kinkhabwala, M., Jan, D., Varadarajan, R., Goldstein, M., ... Shaw Jr, B. W. (2005). Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation. Annals of surgery, 242(4), 556-565. https://doi.org/10.1097/01.sla.0000183973.49899.b1

Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation. / Renz, John F.; Kin, Cindy; Kinkhabwala, Milan; Jan, Dominique; Varadarajan, Rhaghu; Goldstein, Michael; Brown, Robert; Emond, Jean C.; Broelsch, Christoph; Ascher, Nancy L.; Shaw Jr, Byers Wendell.

In: Annals of surgery, Vol. 242, No. 4, 01.10.2005, p. 556-565.

Research output: Contribution to journalArticle

Renz, JF, Kin, C, Kinkhabwala, M, Jan, D, Varadarajan, R, Goldstein, M, Brown, R, Emond, JC, Broelsch, C, Ascher, NL & Shaw Jr, BW 2005, 'Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation', Annals of surgery, vol. 242, no. 4, pp. 556-565. https://doi.org/10.1097/01.sla.0000183973.49899.b1
Renz, John F. ; Kin, Cindy ; Kinkhabwala, Milan ; Jan, Dominique ; Varadarajan, Rhaghu ; Goldstein, Michael ; Brown, Robert ; Emond, Jean C. ; Broelsch, Christoph ; Ascher, Nancy L. ; Shaw Jr, Byers Wendell. / Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation. In: Annals of surgery. 2005 ; Vol. 242, No. 4. pp. 556-565.
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abstract = "Objective: The objective of this study was to evaluate the effect of systematic utilization of extended donor criteria liver allografts (EDC), including living donor allografts (LDLT), on patient access to liver transplantation (LTX). Summary Background Data: 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 regional wait-list priority (RA). This single-institution series compares outcomes of EDC and RA allocation to determine the impact of EDC utilization on donor use and patient access to LTX. Methods: The authors conducted a retrospective analysis of 99 EDC recipients (49 deceased donor, 50 LDLT) and 116 RA recipients from April 2001 through April 2004. Deceased-donor EDC included: age >65 years, donation after cardiac death, positive viral serology (hepatitis C, hepatitis B core antibody, human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, initial graft function, and complication categorized as: biliary, vascular, wound, and other. Results: EDC recipients were more frequently diagnosed with hepatitis C virus or hepatocellular carcinoma and had a lower model for end-stage liver disease (MELD) score at LTX (P < 0.01). 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 deceased-donor EDC recipients were frequently the result of patient comorbidities, whereas LDLT and RA 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 with regional data (P < 0.01). Conclusion: Systematic EDC utilization maximizes donor use, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.",
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T1 - Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation

AU - Renz, John F.

AU - Kin, Cindy

AU - Kinkhabwala, Milan

AU - Jan, Dominique

AU - Varadarajan, Rhaghu

AU - Goldstein, Michael

AU - Brown, Robert

AU - Emond, Jean C.

AU - Broelsch, Christoph

AU - Ascher, Nancy L.

AU - Shaw Jr, Byers Wendell

PY - 2005/10/1

Y1 - 2005/10/1

N2 - Objective: The objective of this study was to evaluate the effect of systematic utilization of extended donor criteria liver allografts (EDC), including living donor allografts (LDLT), on patient access to liver transplantation (LTX). Summary Background Data: 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 regional wait-list priority (RA). This single-institution series compares outcomes of EDC and RA allocation to determine the impact of EDC utilization on donor use and patient access to LTX. Methods: The authors conducted a retrospective analysis of 99 EDC recipients (49 deceased donor, 50 LDLT) and 116 RA recipients from April 2001 through April 2004. Deceased-donor EDC included: age >65 years, donation after cardiac death, positive viral serology (hepatitis C, hepatitis B core antibody, human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, initial graft function, and complication categorized as: biliary, vascular, wound, and other. Results: EDC recipients were more frequently diagnosed with hepatitis C virus or hepatocellular carcinoma and had a lower model for end-stage liver disease (MELD) score at LTX (P < 0.01). 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 deceased-donor EDC recipients were frequently the result of patient comorbidities, whereas LDLT and RA 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 with regional data (P < 0.01). Conclusion: Systematic EDC utilization maximizes donor use, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.

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