OUTCOME ANALYSIS OF MARGINAL DONOR LIVER GRAFTS TRANSPLANTED IN CRITICALLY ILL RECIPIENTS-THE UNOS REGISTRY DATA 1991-1995.

Abstract

86 Background/Purpose: The increasing use of marginal (>50 years) donor livers raises concern whenever a marginal recipient is a potential benefactor. An analysis of the UNOS registry data (1991-1995) for liver transplantation was undertaken to assess the survival differences between stable (UNOS 3) and critically ill (UNOS 1) recipients of marginal (M) and nonmarginal (N) grafts. Methods: Logistic regression analysis of outcomes of 5377 primary adult to adult liver transplants was performed with UNOS 3 recipients (<50 years) of nonmarginal donor liver grafts as the reference group. UNOS 1 recipients were further stratified into those with acute fulminant failure (AcUNOS 1) and those with acute decompensation of chronic liver disease (ChrUNOS 1). The odds of graft failure, patient mortality and retransplantation for groups demonstrating statistically significant differences in outcomes when compared with the reference group are expressed in Table 1. Results: The use of marginal liver grafts increased the odds of adverse patient and graft outcomes to the greatest degree in AcUNOS 1 recipients. Recipient age had a negligible effect on adverse outcomes in stable or critically ill recipients. The odds of retransplantation were greatest for ChrUNOS 1 recipient.Conclusions: Optimal outcomes with marginal liver grafts are more likely to occur in stable recipients. The preferential use of nonmarginal liver grafts may enhance the outcomes of critically ill recipients. The greater likelihood of retransplantation in patients with acute on chronic decompensation argues in favor of the current allocation policy favoring patients with fulminant failure or acute decompensation.