TY - JOUR
T1 - Temporal trends in utilization and outcomes of steatotic donor livers in the United States
AU - Jackson, Kyle R.
AU - Motter, Jennifer D.
AU - Haugen, Christine E.
AU - Holscher, Courtenay
AU - Long, Jane J.
AU - Massie, Allan B.
AU - Philosophe, Benjamin
AU - Cameron, Andrew M.
AU - Garonzik-Wang, Jacqueline
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Steatotic donor livers (SDLs) (macrosteatosis ≥30%) represent a possible donor pool expansion, but are frequently discarded due to a historical association with mortality and graft loss. However, changes in recipient/donor demographics, allocation policy, and clinical protocols might have altered utilization and outcomes of SDLs. We used Scientific Registry of Transplant Recipients data from 2005 to 2017 and adjusted multilevel regression to quantify temporal trends in discard rates (logistic) and posttransplant outcomes (Cox) of SDLs, accounting for Organ Procurement Organization–level variation. Of 4346 recovered SDLs, 58.0% were discarded in 2005, versus only 43.1% in 2017 (P <.001). SDLs were always substantially more likely discarded versus non-SDLs, although this difference decreased over time (adjusted odds ratio in 2005-2007:13.1515.2817.74; 2008-2011:11.7713.4115.29; 2012-2014:9.8711.3713.10; 2015-2017:7.798.8910.15, P <.001 for all). Conversely, posttransplant outcomes of recipients of SDLs improved over time: recipients of SDLs from 2012 to 2017 had 46% lower risk of mortality (adjusted hazard ratio [aHR]: 0.430.540.68, P <.001) and 47% lower risk of graft loss (aHR: 0.420.530.67, P <.001) compared to 2005 to 2011. In fact, in 2012 to 2017, recipients of SDLs had equivalent mortality (aHR: 0.901.041.21, P =.6) and graft loss (aHR: 0.901.041.20, P =.6) to recipients of non-SDLs. Increasing utilization of SDLs might be a reasonable strategy to expand the donor pool.
AB - Steatotic donor livers (SDLs) (macrosteatosis ≥30%) represent a possible donor pool expansion, but are frequently discarded due to a historical association with mortality and graft loss. However, changes in recipient/donor demographics, allocation policy, and clinical protocols might have altered utilization and outcomes of SDLs. We used Scientific Registry of Transplant Recipients data from 2005 to 2017 and adjusted multilevel regression to quantify temporal trends in discard rates (logistic) and posttransplant outcomes (Cox) of SDLs, accounting for Organ Procurement Organization–level variation. Of 4346 recovered SDLs, 58.0% were discarded in 2005, versus only 43.1% in 2017 (P <.001). SDLs were always substantially more likely discarded versus non-SDLs, although this difference decreased over time (adjusted odds ratio in 2005-2007:13.1515.2817.74; 2008-2011:11.7713.4115.29; 2012-2014:9.8711.3713.10; 2015-2017:7.798.8910.15, P <.001 for all). Conversely, posttransplant outcomes of recipients of SDLs improved over time: recipients of SDLs from 2012 to 2017 had 46% lower risk of mortality (adjusted hazard ratio [aHR]: 0.430.540.68, P <.001) and 47% lower risk of graft loss (aHR: 0.420.530.67, P <.001) compared to 2005 to 2011. In fact, in 2012 to 2017, recipients of SDLs had equivalent mortality (aHR: 0.901.041.21, P =.6) and graft loss (aHR: 0.901.041.20, P =.6) to recipients of non-SDLs. Increasing utilization of SDLs might be a reasonable strategy to expand the donor pool.
KW - clinical research/practice
KW - donors and donation: deceased
KW - health services and outcomes research
KW - liver transplantation/hepatology
KW - organ procurement
KW - organ procurement and allocation
KW - registry/registry analysis
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U2 - 10.1111/ajt.15652
DO - 10.1111/ajt.15652
M3 - Article
C2 - 31608597
AN - SCOPUS:85074817482
SN - 1600-6135
VL - 20
SP - 855
EP - 863
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -