Abstracts 1 to 257

2005 Hepatology  
Liver allografts obtained from non-heart beating donors (NHBDs) have been used to address the supply-demand imbalance in liver transplantation, and some centers have demonstrated good posttransplant survival in selected patients that receive NHBD allografts. Such case series do not allow for the increase in mortality associated with these NHBD allografts to be estimated, however, because they lack an adequate control group. Objective: To estimate the increase in mortality and allograft failure
more » ... ttributable to the use of NHBD liver allografts. Methods: All adult patients that have undergone liver transplantation since the implementation of MELD scoring were enrolled through the UNOS OPTN database. Patients with a history of multiorgan transplantation or previous liver transplant were excluded. All recipients of NHBD liver allografts were selected as cases. For each case, a heart-beating donor (HBD) control patient was randomly selected after adjusting for MELD score at the time of transplantation, recipient age, and gender. The Cox proportional hazards model was used for univariate analysis of risk attributable to the use of NHBD allografts. Results: 120 cases and 120 matched controls were obtained. No significant differences between the groups existed for pretransplant variables, including age, creatinine, bilirubin, albumin, incidence of pretransplant life support, or indication for transplantation (pϭns for all analyses). Patient survival rates at 1-year after transplantation were 80.9% and 88.3% for the NHBD and HBD groups, respectively (pϭns). The allograft survival rates one year after transplantation were 65.3% for NHBD cases and 84.3% for HBD controls (hazard ratio 2.35, 95% CI 1.2 -4.8; pϭ0.02). Eight retransplants occurred for every 100 NHBD livers used, for a net gain of 92 transplants; in comparison, approximately 2 retransplants occurred for every 100 HBD livers used in transplantation for a net gain of 98 transplants. Conclusions: A comparison of liver transplant recipients matched for pre-transplant severity of illness, age and gender demonstrates that the risk of 1-year posttransplant patient mortality was not statistically different between recipients of NHBD and HBD liver allografts. NHBD allografts may be a viable option to expand the supply of liver allografts by acting as a bridge to HBD liver transplantation without significantly compromising posttransplant patient mortality. Disclosures: The following authors have indicated they have no relationships to disclose:
doi:10.1002/hep.20923 fatcat:tv6zkkm6gnf2xcyw2qnd74fo3u