Recipient Selection for Optimal Utilization of Discarded Grafts in Liver Transplantation

Background. In France, liver grafts that have been refused by at least 5 teams are considered for rescue allocation (RA), with the choice of the recipient being at the team's discretion. Although this system permits the use of otherwise discarded grafts in a context of organ shortage, outcomes and potential benefits need to be assessed. Methods. Between 2011 and 2015, outcomes of RA grafts (n = 33) were compared with SA grafts (n = 321) at a single French center. Results. Liver grafts in the RA group were older (63 17 years vs 54 +/- 18 years, P = 0.007) and had a higher DRI (1.86 +/- 0.45 vs 1.61 +/- 0.47, P = 0.010). Recipients in this group had a lower Model for End-Stage Liver Disease score (14 +/- 5 vs 22 +/- 10, P < 0.001) and had mostly hepatocellular carcinoma (67.0% vs 40.4%, P = 0.010). The balance of risk score was significantly lower in the RA group (5.5 +/- 2.9 vs 9.2 +/- 5.5, P < 0.001). There were higher rates of early and delayed hepatic artery thrombosis (15.2% vs 3.1%, P = 0.001) and retransplantation (18.2% vs 4.7%, P = 0.002) in the RA group. Patient survival was not different between groups, but graft survival was impaired (95% vs 82% at 1 year and 94% vs 74% at 3 years, P = 0.001). Conclusion. Our results show that discarded liver grafts can be used provided that there is a strict recipient selection process, although hepatic artery thrombosis and retransplantation are more frequent. This strategy enables utilization of otherwise discarded grafts in the context of organ shortage.