A Ten-Year Analysis of Liver Allograft Utilization within the United States.

Abstract

Objectives: 1)To evaluate liver allograft utilization, as determined by allograft availability, origin, and failure probability estimates utilizing the liver donor risk index (LDRI). 2) To correlate allograft utilization with waitlist mortality. Methods: A Scientific Registry of Transplant Recipients (SRTR) search of adult (age≥18years), initial transplant, liver allograft only US recipients from 01/01/03 through 12/31/12 identified 44686 transplant procedures. Origin was categorized as local (LCL), regional (RGN), or national (NTL) by Organ Procurement and Transplant Network (OPTN) classification and LDRI calculated. Allograft availability, donor classification as donation after brain death (DBD) or donation after cardiac death (DCD), and waitlist mortality were integrated through separate SRTR queries. Results: Consented DBD and DCD donors significantly increased over the study period (p<0.01); however, the probabilities of a consented DBD or DCD donor yielding a transplanted liver allograft have declined from a peak of 89% and 44% in 2007 to a decade low 84% and 38%; respectively (p<0.05). LCL allograft utilization has increased while NTL utilization has significantly declined. Median LDRI decreased in 4 of 11 OPTN regions (mean: 5%) while increasing in 6 regions (mean: 8% [ p=NS]). LCL and RGN median LDRI were not significantly different over the study period while NTL median LDRI significantly decreased (p<0.05). Waitlist mortality, as defined by candidates removed for death or too ill for transplantation has not improved. Conclusion: Significant increases in consented DBD and DCD liver allograft donors have not yielded equivalent increases in transplant activity or decreased waitlist mortality due to stagnant allograft acceptance practices and lower utilization of high-risk allografts.