BACKGROUND: There is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received 'livers that nobody wants' (LNWs) in Argentina. METHODS: Between 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival. RESULTS: We transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups. CONCLUSIONS: Transplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence.
BACKGROUND: There is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received 'livers that nobody wants' (LNWs) in Argentina. METHODS: Between 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival. RESULTS: We transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups. CONCLUSIONS: Transplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence.
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Authors: R Adam; H Bismuth; T Diamond; B Ducot; M Morino; I Astarcioglu; M Johann; D Azoulay; L Chiche; Y M Bao Journal: Lancet Date: 1992-12-05 Impact factor: 79.321
Authors: Angus Hann; Anisa Nutu; George Clarke; Ishaan Patel; Dimitri Sneiders; Ye H Oo; Hermien Hartog; M Thamara P R Perera Journal: Transpl Int Date: 2022-05-31 Impact factor: 3.842
Authors: Dustin J Carpenter; Mariana C Chiles; Elizabeth C Verna; Karim J Halazun; Jean C Emond; Lloyd E Ratner; Sumit Mohan Journal: Transplantation Date: 2019-07 Impact factor: 4.939
Authors: Nicolás Goldaracena; Patricio Méndez; Emilio Quiñonez; Gustavo Devetach; Lucio Koo; Carlos Jeanes; Margarita Anders; Federico Orozco; Pablo D Comignani; Ricardo C Mastai; Lucas McCormack Journal: J Transplant Date: 2013-12-12