title: Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of systematic utilization of extended donor criteria liver allografts (EDC), including living donor allografts (LDLT), on patient access to liver transplantation (LTX).
  
  
  BACKGROUND
  Utilization of liver allografts that do not meet traditional donor criteria (EDC) offer immediate expansion of the donor pool. EDC are typically allocated by transplant center rather than regional wait-list priority (RA). This single-institution series compares outcomes of EDC and RA allocation to determine the impact of EDC utilization on donor use and patient access to LTX.
  
  
  METHODS
  The authors conducted a retrospective analysis of 99 EDC recipients (49 deceased donor, 50 LDLT) and 116 RA recipients from April 2001 through April 2004. Deceased-donor EDC included: age >65 years, donation after cardiac death, positive viral serology (hepatitis C, hepatitis B core antibody, human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, initial graft function, and complication categorized as: biliary, vascular, wound, and other.
  
  
  RESULTS
  EDC recipients were more frequently diagnosed with hepatitis C virus or hepatocellular carcinoma and had a lower model for end-stage liver disease (MELD) score at LTX (P < 0.01). Wait-time, technical complications, and hospitalization were comparable. Log-rank analysis of Kaplan-Meier survival estimates demonstrated no difference in patient or graft survival; however, deaths among deceased-donor EDC recipients were frequently the result of patient comorbidities, whereas LDLT and RA deaths resulted from graft failure (P < 0.01). EDC increased patient access to LTX by 77% and reduced pre-LTX mortality by over 50% compared with regional data (P < 0.01).
  
  
  CONCLUSIONS
  Systematic EDC utilization maximizes donor use, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.
authors.affiliation: Center for Liver Disease and Transplantation, New York Presbyterian Hospital, New York, NY 10032, USA. jfr2103@columbia.edu
authors.forename: John F
authors.initials: JF
authors.lastname: Renz
authors.forename: Cindy
authors.initials: C
authors.lastname: Kin
authors.forename: Milan
authors.initials: M
authors.lastname: Kinkhabwala
authors.forename: Dominique
authors.initials: D
authors.lastname: Jan
authors.forename: Rhaghu
authors.initials: R
authors.lastname: Varadarajan
authors.forename: Michael
authors.initials: M
authors.lastname: Goldstein
authors.forename: Robert
authors.initials: R
authors.lastname: Brown
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006297:Health Services Accessibility; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014850:Waiting Lists