Evaluation of liver transplant results with “livers that nobody wants”

Abstract

Background: The shortage of donors to meet the demand for transplants is a global problem. Several strategies have been implemented to ameliorate this situation, including the use of “livers that nobody wants” donors. Outcomes should be evaluated. Methods: CRESI-SINTRA and retrospective data base were used to analyze transplant activity in Argentina and in the Hospital El Cruce (HEC), respectively during 2013–2016. 2 pre-specified groups: 1. patients receiving an organ beyond percentile 75 (p75) of the median of the rejected offers before graft acceptance. 2. rest of receptors. Percentages and median (with interquartile range/IQR), chi2 and Wilconxon Rank Sum test, Kaplan-Meier/log rank sum test were used. A p < 0.05 was considered statistically significative. Results: 1325 liver transplants were performed nationally, 5 (IQR 3-11) as median of rejected offers before graft acceptance. 153 were performed in HEC, and its median was 7 (IQR 3-18), 55/36% of those grafts beyond p75; none used for acute liver failure. Comparing 1 vs 2 (55 vs 72), there were no differences in age, primary nonfunction, early extubation, dialysis, ICU and total length stay, graft and patient survival. Receptor's MELD was the only difference (24 IQR 22-25 vs 28 IQR 25-33 p < 0.05). Conclusion: One third of the population of our center received "livers that nobody wants" (grafts previously rejected 12 times), with similar results. Future research should determine the causes of such rejections.