PMID- 29702538
OWN - NLM
STAT- MEDLINE
DCOM- 20190129
LR  - 20190129
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 102
IP  - 5
DP  - 2018 May
TI  - Utilization of Declined Liver Grafts Yields Comparable Transplant Outcomes and
      Previous Decline Should Not Be a Deterrent to Graft Use.
PG  - e211-e218
LID - 10.1097/TP.0000000000002127 [doi]
AB  - BACKGROUND: In the United Kingdom, up to 20% of liver graft offers are not used
      for transplantation, and the reasons for graft refusal are multifactorial and not
      consistent among transplant units. METHODS: Liver grafts previously declined by
      other transplant centers in the United Kingdom but transplanted in our unit in
      Birmingham between 2011 and 2015 were analyzed. According to the indicated reason
      for previous declines, liver grafts were categorized into 3 refusal groups:
      "quality," "logistics," and "other reasons." Results were compared with a
      matched, low-risk cohort of livers primarily accepted and transplanted at our
      center. RESULTS: During the study period, 206 livers (donation after brain death:
      n = 141 (68.4%); donation after circulatory arrest: n = 65 (31.6%) were
      transplanted, which were previously discarded by a median of 4 other UK centers. 
      The majority of declines were donor quality (n = 102; 49.5%), refusals followed
      by logistics (n = 45; 21.8%), and other reasons (n = 59; 28.6%). Transplantation 
      from both graft types (donation after brain death and donation after circulatory 
      arrest) and all 3 refusal groups achieved equally good outcomes with an overall
      low complication rate. The incidence of primary nonfunction (2.4% vs 1.7%; P =
      0.5483), in-hospital mortality (6.3% vs 4.1%; P = 0.2293) and 3-year graft (82.5%
      vs 84.1%; P = 0.6872) and patient (85.4% vs 87.6%; P = 0.8623) survival was
      comparable between livers previously declined and livers primarily accepted and
      transplanted at our center. CONCLUSIONS: Transplantation of declined livers can
      achieve comparable outcomes to primary liver low-risk graft offers. Previous
      refusal should not be taken as a barrier to use the graft, and with appropriate
      recipient selection, more lives could be saved.
FAU - Marcon, Francesca
AU  - Marcon F
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Schlegel, Andrea
AU  - Schlegel A
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Bartlett, David C
AU  - Bartlett DC
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Kalisvaart, Marit
AU  - Kalisvaart M
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Bishop, Dawn
AU  - Bishop D
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Mergental, Hynek
AU  - Mergental H
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Roberts, Keith J
AU  - Roberts KJ
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Mirza, Darius F
AU  - Mirza DF
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Isaac, John
AU  - Isaac J
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Muiesan, Paolo
AU  - Muiesan P
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
FAU - Perera, M Thamara
AU  - Perera MT
AD  - The Liver Unit, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
SB  - IM
MH  - Adult
MH  - Aged
MH  - Databases, Factual
MH  - *Donor Selection
MH  - End Stage Liver Disease/diagnosis/mortality/*surgery
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Incidence
MH  - Liver Transplantation/adverse effects/*methods/mortality
MH  - Male
MH  - Middle Aged
MH  - Primary Graft Dysfunction/epidemiology
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Tissue Donors/*supply & distribution
MH  - Treatment Outcome
MH  - United Kingdom/epidemiology
EDAT- 2018/04/28 06:00
MHDA- 2019/01/30 06:00
CRDT- 2018/04/28 06:00
PHST- 2018/04/28 06:00 [entrez]
PHST- 2018/04/28 06:00 [pubmed]
PHST- 2019/01/30 06:00 [medline]
AID - 10.1097/TP.0000000000002127 [doi]
AID - 00007890-201805000-00021 [pii]
PST - ppublish
SO  - Transplantation. 2018 May;102(5):e211-e218. doi: 10.1097/TP.0000000000002127.