TY - JOUR
T1 - A regional experience with emergency liver transplantation
AU - Washburn, W. Kenneth
AU - Bradley, James
AU - Cosimi, A. Benedict
AU - Freeman, Richard B.
AU - Hull, David
AU - Jenkins, Roger L.
AU - Lewis, W. David
AU - Lorber, Mark I.
AU - Schweizer, Robert T.
AU - Vacanti, Joseph P.
AU - Rohrer, Richard J.
PY - 1996/1/27
Y1 - 1996/1/27
N2 - Liver transplantation for patients requiring life-support results in the lowest survival and highest costs. A ten year (1983-1993) regional experience with liver transplantation for critically ill patients was undertaken to ascertain the fate of several subgroups of patients. Of the 828 liver transplants performed at six transplant centers within the region over this period, 168 (20%) were done in patients who met today's criteria for a United Network of Organ Sharing (UNOS) status 1 (emergency) liver transplant candidate. Recipients were classified according to chronicity of disease and transplant number (primary-acute, primary-chronic, reTx-acute, reTx-chronic). Overall one-year survival was 50% for all status 1 recipients. The primary- acute subgroup (n=63) experienced a 57% one-year survival compared with 50% for the primary-chronic (n=51) subgroup (P=0.07). Of the reTx-acute recipients (n=43), 44% were alive at one year in comparison with 20% for the reTx-chronic (n=11) group (P=0.18). There was no significant difference in survival for the following: transplant center, blood group compatibility with donors, age, preservation solution, or graft size. For patients retransplanted for acute reasons (primary graft nonfunction (PGNF) or hepatic artery thrombosis [HAT]), survival was significantly better if a second donor was found within 3 days of relisting (52% vs. 20%; P=0.012). Over the study period progressively fewer donor organs came from outside the region. No strong survival-based argument can be made for separating, in allocation priority, acute and chronic disease patients facing the first transplant as a status 1 recipient. Clearly patients suffering from PGNF or HAT do far better if retransplanted within 3 days. Establishing an even higher status for recipients with PGNF, perhaps drawing from a supraregional donor pool, would allow surgeons to accept more marginal donors, thus potentially expanding the pool, without significantly compromising patient survival. Retransplantation of the recipient with a chronically failing graft who deteriorates to the point of needing life-support is nearly futile, and in today's health care climate, not an optimal use of scarce donor livers.
AB - Liver transplantation for patients requiring life-support results in the lowest survival and highest costs. A ten year (1983-1993) regional experience with liver transplantation for critically ill patients was undertaken to ascertain the fate of several subgroups of patients. Of the 828 liver transplants performed at six transplant centers within the region over this period, 168 (20%) were done in patients who met today's criteria for a United Network of Organ Sharing (UNOS) status 1 (emergency) liver transplant candidate. Recipients were classified according to chronicity of disease and transplant number (primary-acute, primary-chronic, reTx-acute, reTx-chronic). Overall one-year survival was 50% for all status 1 recipients. The primary- acute subgroup (n=63) experienced a 57% one-year survival compared with 50% for the primary-chronic (n=51) subgroup (P=0.07). Of the reTx-acute recipients (n=43), 44% were alive at one year in comparison with 20% for the reTx-chronic (n=11) group (P=0.18). There was no significant difference in survival for the following: transplant center, blood group compatibility with donors, age, preservation solution, or graft size. For patients retransplanted for acute reasons (primary graft nonfunction (PGNF) or hepatic artery thrombosis [HAT]), survival was significantly better if a second donor was found within 3 days of relisting (52% vs. 20%; P=0.012). Over the study period progressively fewer donor organs came from outside the region. No strong survival-based argument can be made for separating, in allocation priority, acute and chronic disease patients facing the first transplant as a status 1 recipient. Clearly patients suffering from PGNF or HAT do far better if retransplanted within 3 days. Establishing an even higher status for recipients with PGNF, perhaps drawing from a supraregional donor pool, would allow surgeons to accept more marginal donors, thus potentially expanding the pool, without significantly compromising patient survival. Retransplantation of the recipient with a chronically failing graft who deteriorates to the point of needing life-support is nearly futile, and in today's health care climate, not an optimal use of scarce donor livers.
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U2 - 10.1097/00007890-199601270-00013
DO - 10.1097/00007890-199601270-00013
M3 - Article
C2 - 8600630
AN - SCOPUS:9044248947
VL - 61
SP - 235
EP - 239
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 2
ER -