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HPB (Oxford). 2010 Oct;12(8):523-30. doi: 10.1111/j.1477-2574.2010.00193.x.

Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers 'that nobody wants'.

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  • 1Department of General Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina. lmccormack@hospitalaleman.com

Abstract

BACKGROUND:

There is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received 'livers that nobody wants' (LNWs) in Argentina.

METHODS:

Between 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival.

RESULTS:

We transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n= 1980), followed by LT centre (n= 398) or recipient (n= 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups.

CONCLUSIONS:

Transplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence.

© 2010 International Hepato-Pancreato-Biliary Association.

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