Liver transplant outcomes using late allocation grafts.

Area of Science:

• Transplantation immunology
• Hepatobiliary surgery
• Organ procurement and allocation

Background:

• Late allocation (LA) liver allografts face higher discard rates due to logistical challenges.
• Standard allocation (SA) is the conventional method for liver allograft distribution.

Purpose of the Study:

• To compare outcomes of liver transplants (LT) using LA allografts versus SA allografts.
• To identify factors influencing the discard of LA liver allografts.
• To evaluate the safety and efficacy of LA liver allografts.

Main Methods:

• Nearest neighbor propensity score matching was used to compare LA and SA liver offers.
• Logistic regression model included recipient age, sex, graft type, MELD, and DRI score.
• A cohort of 101 liver transplants using LA offers between 2015 and 2021 was analyzed.

Main Results:

• No significant differences were observed in recipient characteristics between LA and SA groups.
• LA grafts originated from younger donors and were more likely from regional/national Organ Procurement Organizations (OPOs).
• Cold ischemia time was longer for LA grafts, but patient and graft survival rates were comparable (1-year survival: 95.1% LA vs. 95.0% SA for patients; 93.1% LA vs. 92.1% SA for grafts).

Conclusions:

• Liver transplantation outcomes using LA grafts are similar to those using SA grafts, despite increased logistical complexity and cold ischemia time.
• Improving LA-specific allocation policies and fostering collaboration between transplant centers and OPOs can minimize allograft discards.
• LA liver allografts represent a viable option for increasing the donor liver pool and improving access to transplantation.