Giovanni Giretti1, Louise Barbier1,2,3, Petru Bucur1,2,3, Frédéric Marques1,2,3, Jean-Marc Perarnau4, Martine Ferrandière5, Anne-Charlotte Tellier5, Vincent Kerouredan5, Mario Altieri6, Xavier Causse3,7, Maryline Debette-Gratien3,8,9, Christine Silvain3,10, Ephrem Salamé1,2,3. 1. Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours. 2. INSERM, Poitiers, France. 3. FHU SUPORT, Tours, France. 4. Department of Hepatology, University Hospital of Tours. 5. Intensive Care Unit, University Hospital of Tours. 6. Department of Hepatology, University Hospital of Caen, Caen, France. 7. Department of Hepatology, Regional Hospital of Orleans, Orléans, France. 8. Department of Hepatology and Gastroenterology, University Hospital of Limoges, Limoges, France. 9. INSERM, Limoges, France. 10. Department of Hepatology, University Hospital of Poitiers, Poitiers, France.
Abstract
BACKGROUND: In France, liver grafts that have been refused by at least 5 teams are considered for rescue allocation (RA), with the choice of the recipient being at the team's discretion. Although this system permits the use of otherwise discarded grafts in a context of organ shortage, outcomes and potential benefits need to be assessed. METHODS: Between 2011 and 2015, outcomes of RA grafts (n = 33) were compared with SA grafts (n = 321) at a single French center. RESULTS: Liver grafts in the RA group were older (63 ± 17 years vs 54 ± 18 years, P = 0.007) and had a higher DRI (1.86 ± 0.45 vs 1.61 ± 0.47, P = 0.010). Recipients in this group had a lower Model for End-Stage Liver Disease score (14 ± 5 vs 22 ± 10, P < 0.001) and had mostly hepatocellular carcinoma (67.0% vs 40.4%, P = 0.010). The balance of risk score was significantly lower in the RA group (5.5 ± 2.9 vs 9.2 ± 5.5, P < 0.001). There were higher rates of early and delayed hepatic artery thrombosis (15.2% vs 3.1%, P = 0.001) and retransplantation (18.2% vs 4.7%, P = 0.002) in the RA group. Patient survival was not different between groups, but graft survival was impaired (95% vs 82% at 1 year and 94% vs 74% at 3 years, P = 0.001). CONCLUSION: Our results show that discarded liver grafts can be used provided that there is a strict recipient selection process, although hepatic artery thrombosis and retransplantation are more frequent. This strategy enables utilization of otherwise discarded grafts in the context of organ shortage.
BACKGROUND: In France, liver grafts that have been refused by at least 5 teams are considered for rescue allocation (RA), with the choice of the recipient being at the team's discretion. Although this system permits the use of otherwise discarded grafts in a context of organ shortage, outcomes and potential benefits need to be assessed. METHODS: Between 2011 and 2015, outcomes of RA grafts (n = 33) were compared with SA grafts (n = 321) at a single French center. RESULTS: Liver grafts in the RA group were older (63 ± 17 years vs 54 ± 18 years, P = 0.007) and had a higher DRI (1.86 ± 0.45 vs 1.61 ± 0.47, P = 0.010). Recipients in this group had a lower Model for End-Stage Liver Disease score (14 ± 5 vs 22 ± 10, P < 0.001) and had mostly hepatocellular carcinoma (67.0% vs 40.4%, P = 0.010). The balance of risk score was significantly lower in the RA group (5.5 ± 2.9 vs 9.2 ± 5.5, P < 0.001). There were higher rates of early and delayed hepatic artery thrombosis (15.2% vs 3.1%, P = 0.001) and retransplantation (18.2% vs 4.7%, P = 0.002) in the RA group. Patient survival was not different between groups, but graft survival was impaired (95% vs 82% at 1 year and 94% vs 74% at 3 years, P = 0.001). CONCLUSION: Our results show that discarded liver grafts can be used provided that there is a strict recipient selection process, although hepatic artery thrombosis and retransplantation are more frequent. This strategy enables utilization of otherwise discarded grafts in the context of organ shortage.
Authors: Audrey Winter; Paul Landais; Daniel Azoulay; Mara Disabato; Philippe Compagnon; Corinne Antoine; Christian Jacquelinet; Jean-Pierre Daurès; Cyrille Féray Journal: JHEP Rep Date: 2020-05-04
Authors: Andrew M Bishara; Dmytro S Lituiev; Dieter Adelmann; Rishi P Kothari; Darren J Malinoski; Jacob D Nudel; Mitchell B Sally; Ryutaro Hirose; Dexter D Hadley; Claus U Niemann Journal: Transplant Direct Date: 2021-09-27