Should we use liver grafts repeatedly refused by other transplant teams?

JHEP Reports : Innovation in Hepatology
Audrey WinterCyrille Feray

Abstract

In France, liver grafts that have been refused at least 5 times can be "rescued" and allocated to a centre which chooses a recipient from its own waiting list, outside the patient-based allocation framework. We explored whether these "rescued" grafts were associated with worse graft/patient survival, as well as assessing their effect on survival benefit. Among 7,895 candidates, 5,218 were transplanted between 2009 and 2014 (336 centre-allocated). We compared recipient/graft survival between patient allocation and centre allocation, considering a selection bias and the distribution of centre-allocation recipients among the transplant teams. We used a propensity score approach and a weighted Cox model using the inverse probability of treatment weighting method. We also explored the survival benefit associated with centre-allocation grafts. There was a significantly higher risk of graft loss/death in the centre allocation group compared to the patient allocation group (hazard ratio 1.13; 95% CI 1.05-1.22). However, this difference was no longer significant for teams that performed more than 7% of the centre-allocation transplantations. Moreover, receiving a centre-allocation graft, compared to remaining on the waiting list and pos...Continue Reading

References

Feb 15, 2001·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·P S KamathW R Kim
Jul 20, 2006·Seminars in Liver Disease·Barbara AlkoferJohn F Renz
Mar 16, 2007·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·N R BarshesJ A Goss
Jan 15, 2008·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·D E SchaubelR M Merion
Dec 16, 2009·Clinical Transplantation·Peter SchemmerJan Schmidt
Aug 18, 2010·Scandinavian Journal of Gastroenterology·Axel DoeneckeAiman Obed
Jun 23, 2011·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Claire FrancozFrançois Durand
Oct 30, 2012·Journal of Hepatology·Javier BriceñoManuel de la Mata
Jul 10, 2013·Transplant International : Official Journal of the European Society for Organ Transplantation·Anne MossdorfChristoph Heidenhain
Feb 1, 2017·Liver International : Official Journal of the International Association for the Study of the Liver·Audrey WinterPaul Landais
Jan 4, 2018·Transplantation·Giovanni GirettiEphrem Salamé

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