21. Utilization Of Extended Donor Criteria Liver Allografts Maximizes Donor Utility and Patient Access To Liver Transplantation
John Renz, MD PhD*, Cindy Kin, MD*, Milan Kinkhabwala, MD*, Dominique Jan, MD*, Rhagu Varadarajan, MD*, Michael Goldstein, MD*, Robert Brown, Jr., MD MPH*, Jean C. Emond, MD
New York Presbyterian Hospital, New York, NY

OBJECTIVE: Utilization of liver allografts that do not meet traditional donor criteria (EDC) offer immediate expansion of the donor pool. EDC are typically allocated by transplant center rather than wait-list priority (UNOS). This study evaluates systematic application of EDC, including living-donor allografts (LD), on patient access to LTX.
METHODS: Retrospective analysis of 99 EDC recipients (49 cadaver, 50 LD) and 128 UNOS recipients from 04/01 through 04/04. Cadaver-EDC included: age>65yr, donation after cardiac death, viral serology (hepatitis C [HCV], human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, and complication categorized as: biliary, vascular, wound, and delayed or primary graft nonfunction.
RESULTS: EDC recipients were more frequently diagnosed with HCV or hepatoma and had a lower model for end stage liver disease (MELD) score at LTX (p<0.01vsUNOS). Wait-time, technical complications, and hospitalization were comparable. Log-Rank analysis of Kaplan-Meier survival estimates demonstrated no difference in patient or graft survival; however, deaths among cadaver-EDC recipients were principally the result of patient co-morbidities while LD and UNOS deaths resulted from graft failure (p<0.01) EDC increased patient access to LTX by 77% and reduced pre-LTX mortality by over 50% compared to regional data (p<0.01).
CONCLUSION: Systematic EDC utilization maximizes donor utility, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.

TABLE #1

PARAMETER	EDC	LD	UNOS	p
MELD(S.D.)	22(11)	16(5)	25(12)	<0.01
WAIT-TIME(S.D.)	188(218)	265(296)	222(300)	NS
HOSPITALIZATION(S.D) (days)	22(26)	14(9)	27(31)	NS
KAPLAN-MEIER 1 MONTH GRAFT (%)	88	95	94	NS
KAPLAN-MEIER 1 YEAR GRAFT (%)	80	85	82	NS
KAPLAN-MEIER 2 YEAR GRAFT (%)	74	82	77	NS
KAPLAN-MEIER 1 MONTH PATIENT (%)	89	100	94	NS
KAPLAN-MEIER 1 YEAR PATIENT (%)	80	89	84	NS
KAPLAN-MEIER 2 YEAR PATIENT (%)	76	87	79	NS

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