UNOS Data Analysis of Discarded Liver-Grafts After Procurement.

Abstract

Liver grafts are discarded after procurement due to a variety of reasons with implications on the cost and resources. We analyzed UNOS database to study trends and reasons for discarded livers from 01/1998 to 12/2012. 91,283 livers were procured, 82,262 [90.12%, 5,484.1/year] were used for a transplant and 9,021 [9.88%, 601.4/year] were discarded. The number of livers transplanted increased significantly from 2001 until 2007, then decreased in 2008 and plateaued since then. The discard rate had marginally increased between 2003 to 2007 and after that plateaued.Figure: No Caption available.The commonest cause reported for the discard was biopsy finding without significant trend [4,069(45.1%)]. 222(2.32%) livers found no suitable recipient with increasing trend. Social history, CMV positivity, hepatitis or the donor medical history were given reasons for discarding 377(2.78%) livers. There was a steady increase in livers being discarded for warm ischemia time [336 (3.52%)] over last 5 years as a result of increasing DCD donors. 239(2.5%) were discarded due to recipient unsuitability for transplant in the OR with constant increase, suggestive of trend towards accepting high risk recipients. Vascular damage, trauma and anatomical abnormalities resulted in 143(1.5%), 155(1.62%) and 644(6.74%) discards respectively with only later showing an increasing trend. From 1998 until 2007, 443 (4.64%) grafts were discarded with the reason “not reported”; however since 2007, there was none discarded citing this reason. 1,456[15.2%, 97.1/year] livers were discarded for “other specific reasons” with no trend. Organs described as “diseased” and “poor function” resulted in 648 (6.78%) and 476(4.98%) discards respectively; though vague both categories, it showed a gradual increase from 1998 to 2008 and after that a decline. In conclusion the number of livers discarded after procurement has been steady over the last 15 years with biopsy reading as the commonest cause. Since these readings are commonly performed by non-specialized pathologists, more data on the reliability of it and ways to standardized reporting, might allow improvements that could increase utilization.