title: Outcome of imported liver allografts and impact on patient access to liver transplantation.
abstract: Liver allografts declined by local transplant centers are then offered regionally or nationally as imported grafts. Most of these grafts are declined because of poor donor quality. We retrospectively reviewed the medical records of patients who underwent liver transplantation between January 2004 and December 2005. There were 102 liver transplants in 98 recipients. They were divided into two groups: imported graft recipients (n = 37) and locally procured grafts recipients (n = 61). Eighty-six percent (32 of 37) of imported grafts were obtained from extended criteria donors defined as subjects treated with high doses of ionotropes with elevated liver enzymes, donor age over 70 years, macrosteatosis above 25%, positive hepatitis C or hepatitis B core antibody serology, systemic disease, history of cancer, hypernatremia, or with infection. The remaining grafts were declined due to unavailability of suitable recipients or social history. Recipient age and etiology of liver disease were similar for both groups. The mean MELD score was 22.1 +/- .9 among the imported graft recipients and 26.1 +/- 1 for the locally procured graft recipients (P < .01). There was no difference in blood loss or postoperative complications. Postoperative mean peak total bilirubin was similar in both groups. However, imported graft recipients had significantly higher mean peak AST (2436 +/- 282 vs 1380 +/- 165 U/L, P < .001) and ALT (1098 +/- 114 vs 803 +/- 87 U/L, P < .05). Primary graft nonfunction as well as 30 day and 1-year patient and graft survivals were similar for both groups. In conclusion, imported grafts can be transplanted in selected patients with outcomes comparable to locally procured grafts.
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15237, USA. mohamed.akoad@med.va.gov
authors.forename: M
authors.initials: M
authors.lastname: Akoad
authors.forename: M
authors.initials: M
authors.lastname: Wagener
authors.forename: F
authors.initials: F
authors.lastname: Francis
authors.forename: J
authors.initials: J
authors.lastname: Ahmed
authors.forename: D
authors.initials: D
authors.lastname: Ulizio
authors.forename: T V
authors.initials: TV
authors.lastname: Cacciarelli
mesh_terms: D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D018579:Patient Selection; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D014184:Transplantation, Homologous; D016896:Treatment Outcome