Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers 'that nobody wants'.
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.
McCormack
Lucas
L
Department of General Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina. lmccormack@hospitalaleman.com
Quiñonez
Emilio
E
Ríos
María Martha
MM
Capitanich
Pablo
P
Goldaracena
Nicolás
N
Cabo
Javier Kerman
JK
Anders
Margarita
M
Osatnik
Javier
J
Comignani
Pablo
P
Mezzadri
Norberto
N
Mastai
Ricardo Cesar
RC
D000328:Adult; D000368:Aged; D001118:Argentina; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D046148:Donor Selection; D017558:Elective Surgical Procedures; D005260:Female; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult