S. Gotewal1, C. Hwang1, J. Reese1, J. Parekh1, M. MacConmara1 1University Of Texas Southwestern Medical Center,Transplant,Dallas, TEXAS, USA
Introduction: Utilization patterns of marginal donor livers vary throughout the different donation service areas (DSA) and regions in the US. In addition, aggressive utilization is not uniform across all types of marginal donors. The aim of this study was to examine the procurement, utilization and discard of marginal livers by the organ procurement organization (OPO) in the North Texas DSA and to compare this with the national trend in order to identify areas for potential increase in organ utilization.
Methods: This retrospective study identified all donors between January 1, 2013 and September 30, 2015 in the North Texas DSA, in which the intent at time of donor procurement was to use the liver for transplant. Donor age, type, BMI were collected together with serologies, biochemistry and macrovesicular fat content. In addition, use or discard of the liver was confirmed through OPO records. In the event of discard further data regarding the underlying reason was obtained. Marginal organ utilization rates were then compared with national data available through the SRTR database.
Results: 703 donor liver procurements took place during the study period and of these 628 were transplanted and 75 (10.7%) discarded. Older age (>65 years), donation after cardiac death (DCD) status and macrovesicular fat content (>30%) were all associated with statistically higher rates of discard. Interestingly, older age had a higher discard rate when compared with national trends (23% vs. 17%). Within this subgroup macrovesicular fat content (6% vs. 16.5% national), average BMI (27.7 vs. 28.4), and DCD status (0/36 vs. 28/175 national) would all suggest that these organs would be of better quality. OPO records noted severe calcification within visceral arteries as the reason for organ decline and discard 7 of the cases. Importantly, when a second transplant surgeon was present at the procurement none of the organs were discarded. Of the 44 livers above age 65, a second surgeon was present on 8, and had 0 discards. There were 10 discards over age 65 when a second surgeon was not present (p=.045).
Conclusion: Marginal livers from donors of advanced age are less frequently used in North Texas. These data suggest that many were discarded for subjective causes. Importantly, the presence of another surgeon may act to increase utilization.