Utilisation of declined liver grafts yields comparable transplant outcomes and previous decline should not be a deterrent to graft use

ABSTRACTBackground:In the United Kingdom, up to 20% of liver graft offers are not utilized for transplantation and the reasons for graft refusal are multi-factorial and not consistent amongst transplant units.Methods:Liver grafts previously declined by other transplant centers in UK but transplanted in our unit in Birmingham between 2011 and 2015 were analyzed. According to the indicated reason for previous declines, liver grafts were categorized into 3 refusal groups: "quality", "logistics" and "other reasons". Results were compared to a matched, low risk cohort of livers primarily accepted and transplanted at our center.Results:During the study period, 206 livers (DBD: n=141 (68.4%); DCD: n=65 (31.6%) were transplanted, which were previously discarded by a median of 4 other UK centres. The majority of declines were donor quality (n=102; 49.5%) refusals followed by logistics (n=45; 21.8%) and other reasons (n=59; 28.6%). Transplantation from both graft types (DBD and DCD) and all 3 refusal groups achieved equally good outcomes with an overall low complication rate. The incidence of primary-non-function (PNF, 2.4%vs.1.7%; p=0.5483), in-hospital mortality (6.3%vs.4.1%; p=0.2293) and 3-year graft (82.5% vs. 84.1%; p=0.6872)- and patient (85.4%vs.87.6%; p=0.8623) survival was comparable between livers previously declined and livers primarily accepted and transplanted at our centre.Conclusion:Transplantation of declined livers can achieve comparable outcomes to primary liver low risk graft offers. Previous refusal should not be taken as a barrier to use the graft and with appropriate recipient selection more lives could be saved. Background: In the United Kingdom, up to 20% of liver graft offers are not utilized for transplantation and the reasons for graft refusal are multi-factorial and not consistent amongst transplant units. Methods: Liver grafts previously declined by other transplant centers in UK but transplanted in our unit in Birmingham between 2011 and 2015 were analyzed. According to the indicated reason for previous declines, liver grafts were categorized into 3 refusal groups: "quality", "logistics" and "other reasons". Results were compared to a matched, low risk cohort of livers primarily accepted and transplanted at our center. Results: During the study period, 206 livers (DBD: n=141 (68.4%); DCD: n=65 (31.6%) were transplanted, which were previously discarded by a median of 4 other UK centres. The majority of declines were donor quality (n=102; 49.5%) refusals followed by logistics (n=45; 21.8%) and other reasons (n=59; 28.6%). Transplantation from both graft types (DBD and DCD) and all 3 refusal groups achieved equally good outcomes with an overall low complication rate. The incidence of primary-non-function (PNF, 2.4%vs.1.7%; p=0.5483), in-hospital mortality (6.3%vs.4.1%; p=0.2293) and 3-year graft (82.5% vs. 84.1%; p=0.6872)- and patient (85.4%vs.87.6%; p=0.8623) survival was comparable between livers previously declined and livers primarily accepted and transplanted at our centre. Conclusion: Transplantation of declined livers can achieve comparable outcomes to primary liver low risk graft offers. Previous refusal should not be taken as a barrier to use the graft and with appropriate recipient selection more lives could be saved. Correspondence: Mr. Thamara Perera †, Consultant Liver Transplant Surgeon, The Liver Unit, Queen Elizabeth hospital Birmingham, Edgbaston, Birmingham, United Kingdom, B15 2TH. E-mail: Thamara.Perera@uhb.nhs.uk FM & AS contributed equally as first authors Retrospective cohort study approved by local authorities: CARMS-12498, CARMS-02246 AUTHORSHIP PAGE Participated in research design: F. Marcon, A. Schlegel, P. Muiesan, M.T.P.R. Perera Participated in the writing of the paper: F. Marcon, A. Schlegel, H. Mergental K. Roberts, D.F. Mirza, J. Isaac, P. Muiesan, M.T.P.R. Perera Participated in the performance of the research: F. Marcon, A. Schlegel, D. Bartlett, M. Kalisvaart, D.R. Bishop Contributed new reagents or analytic tools: n.a. Participated in data analysis: F. Marcon, A. Schlegel, M. Kalisvaart, M.T.P.R. Perera Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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