Table of Contents
July 12, 2024
Delayed liver transplantation provides an additional opportunity for patients waiting for a liver transplant. Transplant surgeons at Mayo Clinic, Arizona, accept and use late-allocation grafts with good results.
In recent years, the United States has seen an increase in both the number of liver transplants performed and the number of livers recovered for transplantation but ultimately not transplanted.
A variety of factors limit patient access to liver transplantation, including ongoing organ shortages and differences in acceptance patterns at transplant centers.
innovative options
Because there is little information regarding posttransplant outcomes specific to these grafts, Mayo Clinic, Arizona transplant surgery researchers sought to evaluate the characteristics and outcomes of late allocation (LA) allografts.
In a study published in December 2023 in the journal Liver Transplantation, Mayo Clinic transplant surgeons found that post-cross-clamp liver allograft offers can enable additional liver transplant opportunities.
“Liver offer acceptance and transplantation rates vary by transplant center, compounding the existing challenge of organ shortage. Transplantation of liver allografts after recovery, also known as post-clamp or late allocation offers, is difficult. For recipients waiting for a liver transplant, there is still a high risk that a late allocated liver offer will not be taken advantage of due to logistical issues. said Caroline C. Jadrowiec, M.D., surgical director of the Mayo Clinic Kidney Transplant Program in Arizona and one of the study authors.
Challenge using LA's liver
- There is a need to rapidly reinterpret available data.
- Manage potential obstacles such as distance, timing, and transportation.
- Addressing unknown variables that contribute to intraoperative decline.
- Prolongation of cold ischemia time (CIT).
Although there are hurdles, good results can be achieved using delayed transplants. “These liver allografts achieve outcomes comparable to standard allocation liver allografts, although they require more complex adjustments and longer periods of CIT,” says Dr. Jadlowiec.
This study focused on LA liver allografts transplanted at Mayo Clinic in Arizona between 2015 and 2021. Of the 895 liver-only transplants performed at the clinic, 101 (11.3%) were performed using late allocation offers.
All late-allocated grafts in this study were originally allocated and rejected by other transplant centers. Liver allografts were stored statically and refrigerated. Machine perfusion was not used during this study period.
Main findings
- Between 2015 and 2021, 11.3% of liver transplants performed at Mayo Clinic in Arizona were performed at LA offers.
- Most allografts were donated after brain death. The donors were young and the majority had normal preimplantation biopsies.
- Despite longer CIT and increased allograft dysfunction, there were no differences in intensive care unit and hospital stay, patient survival, or graft survival.
- Liver allografts with late allocation had an average of 2 hours additional CIT compared to liver allografts donated with standard allocation.
late transplant success
The goal is to minimize unuse of all potential organs. The Mayo Clinic Transplant Center in Arizona says timely communication between the recovery team, organ procurement organization (OPO), and potential recipient is critical to allow for rapid assessment and logistics planning. are.
Most late assignment offers in this cohort were from regional and national OPOs. Successful use of late allocated grafts depends on geography and transportation availability.
patient education
Mayo Clinic Arizona's innovative thinking about organ acceptance includes planning and preparation. “Providing patient education about donor characteristics and allocation possibilities will help them be prepared,” Dr. Jadrowiec says. “It is also important to ensure timely access to patients on the waiting list who are ready to receive a transplant, especially if there are delays in liver allocation.”
What's next?
Improving allocation policies specific to LA offers and sharing best practices between transplant centers and OPOs is essential. “Mayo Clinic Transplant Center in Arizona continues to further expand its liver transplant opportunities through both the use of late allocation offers and the use of allografts from circulating deceased donors and post-machine perfusion donations.” Dr. Jadrowiec says. “For patients waiting for a liver transplant, there are even more opportunities to further increase access to transplantation.”
For more information
Jadrowiec C et al. Outcomes of liver transplantation using late-allocated grafts. Liver transplant. 2023;29:1323.
Refer the patient to Mayo Clinic.
