OUTCOMES OF ORTHOTOPIC LIVER TRANSPLANTS USING EXTENDED CRITERIA DONOR LIVERS

Abstract

P570 Aims: Extended criteria donor (ECD) liver utilization has expanded the limited donor pool for patients awaiting orthotopic liver transplant (OLT). Many centers approach ECD livers with caution as the outcomes following their use remains unclear. The goal of this review was to analyze outcomes of OLT using ECD livers compared to a control group of standard criteria donor (SCD) liver allografts. Methods: All OLT recipients at our center between Jan 2002-Oct 2003 were categorized as having received an ECD or SCD liver. ECD allografts were defined as having any one or more of the following: donor age > 60 yrs, biopsy exhibiting >40% macrovesicular and/or >75% microvesicular steatosis, any donor down time (±CPR), use of 2 or more pressors within 12 hrs of procurement, or liver function studies > 5 × upper limit of normal. Parameters that were reviewed included: recipient demographics (age, sex, MELD, mean follow-up, length of stay), graft ischemic times (total and warm), laboratory data, and clinical outcomes (death, biliary complications, rejections). Results: 90 OLTs (42 ECD and 48 SCD) were performed during the study period. No statistical differences were observed in laboratory data including: serum creatinine, transaminases (AST/ALT), total bilirubin, and albumin at discharge, day 30, 90, and 180 for both groups. The two groups were similar with respect to rejection episodes per patient ECD (1.1) vs. SCD (1.3) [p=ns]. Five instances of vascular complications were identified (3 ECD vs. 2 SCD), although only one of those was a hepatic artery thrombosis. Conclusions: Clinical outcomes following OLT using ECD livers are identical to those using SCD livers. No differences were noted insofar as early or mid laboratory values, LOS, biliary or vascular complications. With intelligent recipient selection, the aggressive use of ECD liver allografts can become an important component of any transplant program.Figure