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. 2024 May 3;10(6):e1605.
doi: 10.1097/TXD.0000000000001605. eCollection 2024 Jun.

A Decade of Liver Transplantation in the United States: Drivers of Discard and Underutilization

Julia Torabi  1   2 , Rachel Todd  2 , L Leonie van Leeuwen  3 , Yuki Bekki  3 , Matthew Holzner  3 , Jang Moon  3 , Tom Schiano  3 , Sander S Florman  3 , Mohammed Zeeshan Akhtar  3
Affiliations

A Decade of Liver Transplantation in the United States: Drivers of Discard and Underutilization

Julia Torabi et al. Transplant Direct. .

Abstract

Background: Organ shortage remains a major challenge for the field of transplantation. Maximizing utilization and minimizing discard of available organs is crucial to reduce waitlist times. Our aim was to investigate the landscape of liver recovery, discard over the past decade in the United States, and identify areas to reduce organ discard.

Methods: This study used the Scientific Registry of Transplant Recipients United Network for Organ Sharing database to analyze the rates and associated reasons of discarded organs from 2010 to 2021. All deceased donors were evaluated, and data were analyzed by organ type, year, and region. Organ disposition was analyzed by year and region. Donor demographics and liver biopsy data were also analyzed.

Results: The volume of liver transplantation increased steadily, with a 44% increase from 2010 to 2021. Donation after circulatory death transplantation increased by 239%, comprising 10.6% of transplants in 2021, yet discard rates remained high at 30% for this donor subset. For all donor types, the liver discard rate has remained stable around 10% despite a 74% increase in available donors. Seventy percent of liver discards were attributed to organ factors, with biopsy findings accounting for 40% of all discards. Of livers that were biopsied, 70% had macrosteatosis of <30%.

Conclusions: Analysis of trends in transplantation and discard allow for identifying areas of underutilization. Donation after circulatory death livers have expanded the pool of transplanted livers but remain discarded at high rates. Significant differences remain in discard rates between geographic regions. We identify several areas to lower the discard rates. The expanding role of machine perfusion may allow for utilization of previously discarded organs.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Liver transplant volume and discard rate from 2010 to 2021. A, All potential deceased donor livers and outcome of nonrecovery, discard, or transplantation from 2010 to 2021. B, The national nonrecovery rate and discard rate of recovered deceased donor liver allografts.
FIGURE 2.
FIGURE 2.
Discard and utilization of SCD, ECD, and DCD donors between 2010 and 2021. A, Transplanted livers by donor type from 2010 to 2021. B, Discarded livers by donor type between 2010 and 2021. C, Discard rate by donor type between 2010 and 2021. DCD, donation after circulatory death; ECD, expanded criteria donor; SCD, standard criteria donor.
FIGURE 3.
FIGURE 3.
How age and BMI correlate with usability of organs for transplant. Donor (A) age and (B) BMI of transplanted, discard, and nonrecovered liver grafts between 2010 and 2021. BMI, body mass index.
FIGURE 4.
FIGURE 4.
Discard rates and transplant volume between 2010 and 2021 by region.
FIGURE 5.
FIGURE 5.
Liver biopsy volumes and rates from 2010 to 2021. A, Volume of liver biopsies performed of nonrecovered, discarded, and transplanted livers by year. B, Liver biopsy rate of all available donors by year. C, Macrosteatosis of biopsied livers. D, Fibrosis score of livers.
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References

    1. Kwong AJ, Ebel NH, Kim WR, et al. . OPTN/SRTR 2020 annual data report: liver. Am J Transplant. 2022;22(Suppl 2):204–309. - PubMed
    1. Eurotransplant Annual Report. Statistics Report Library. Available at https://statistics.eurotransplant.org. Accessed August 19, 2023.
    1. Halazun KJ, Quillin RC, Rosenblatt R, et al. . Expanding the margins: high volume utilization of marginal liver grafts among >2000 liver transplants at a single institution. Ann Surg. 2017;266:441–449. - PubMed
    1. Danford CJ, Redman JS, Alonso D. Hepatitis C-positive liver transplantation: outcomes and current practice. Curr Opin Organ Transplant. 2021;26:115–120. - PubMed
    1. Goldaracena N, Cullen JM, Kim DS, et al. . Expanding the donor pool for liver transplantation with marginal donors. Int J Surg. 2020;82:30–35. - PubMed