Improved Waitlist Outcomes in Liver Transplant Patients With Mid-MELD-Na Scores Listed in Centers Receptive to Use of...

Area of Science:

• Hepatology
• Transplantation Surgery
• Organ Donation

Background:

• Liver transplantation (LT) utilizing organs from donors after circulatory death (DCD) is increasingly prevalent in the US.
• Investigating the impact of transplant center receptiveness to DCD organs on patient outcomes is crucial.

Purpose of the Study:

• To determine if transplant centers' willingness to use DCD organs affects patient outcomes.
• To analyze the relationship between DCD organ acceptance rates and liver transplant success.

Main Methods:

• Classified transplant centers into three groups based on DCD acceptance rates and transplant percentages.
• Analyzed data from 20,435 patients listed for LT (Jan 2020-June 2022) using UNOS registry data.
• Compared 1-year transplant probability and waitlist mortality across groups, stratified by Model for End-Stage Liver Disease-Sodium (MELD-Na) scores.

Main Results:

• Centers highly receptive to DCD organs (Group 1) showed significantly higher transplant probabilities for MELD-Na 6-29 compared to less receptive centers (Group 3).
• Group 1 centers also demonstrated reduced waitlist mortality for MELD-Na 20-29 compared to Group 3 and Group 2.
• One-year post-transplant survival for DCD LT did not differ significantly from donation after brain death.

Conclusions:

• Increased utilization of DCD liver organs by transplant centers can enhance waitlist outcomes.
• Mid-MELD-Na score patients particularly benefit from centers with higher DCD organ acceptance.
• Center receptiveness to DCD organs is a key factor in improving liver transplant accessibility and patient survival on the waitlist.