Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation

Area of Science:

• Transplantation research
• Organ donation science
• Hepatology

Background:

• Public Health Service (PHS) increased risk donor (IRD) organs are underutilized in liver transplantation.
• Limited data exists on posttransplant outcomes for recipients of IRD organs.

Purpose of the Study:

• To examine posttransplant outcomes in liver transplant recipients who received organs from IRD versus non-IRD donors.
• To identify demographic differences and clinical outcomes associated with IRD organ utilization.

Main Methods:

• Analysis of 228,040 liver transplants from the Organ Procurement and Transplantation Network database (2004-2013).
• Comparison of graft failure and mortality rates between IRD and non-IRD groups.
• Statistical analysis using Fisher's test and logistic regression, controlling for demographics and comorbidities.

Main Results:

• IRD donors were more frequently male, younger, and less likely to have comorbidities.
• Liver transplant recipients of IRD organs had longer waitlist times but better initial outcomes.
• Graft failure and mortality were lower in the IRD group before multivariate analysis (p < 0.001).

Conclusions:

• This study provides the first demographic description of IRD organ use in liver transplantation.
• While initial outcomes favored IRD recipients, multivariate analysis revealed noninferiority, with similar graft failure and mortality rates after controlling for confounding factors.
• IRD organ utilization is a viable option with comparable long-term outcomes to non-IRD organs, despite the inherent infectious risks.