2020 - Aliyah Hussein

Risk factors for retrieved but not transplanted deceased donor livers in the UK: a national registry analysis

Introduction: On occasion, organs are retrieved but not transplanted (RNT) due to adverse features found at organ retrieval, or logistical or recipient-related issues. This study examines the donor and organ risk factors associated with RNT livers and explores variation in RNT rates between centres.

Method: UK Transplant Registry data were collected on donor and organ characteristics for livers retrieved from adult deceased donors for transplantation from 2006 to 2017. Logistic regression models were built to determine the factors associated with RNT. Organ risk was quantified using the UK Donor Liver Index (UKDLI – Collett et al, 2017).

Result: Of the 9203 livers retrieved, 1009 (11%) livers were not transplanted (51% DBD donors, 49% DCD donors). For DBD and DCD donors the following were statistically significant in influencing whether a liver was RNT: steatosis, age, BMI, organ appearance, bilirubin, and accepting transplant centre. Of these, donor type and organ appearance were most important. Among transplant centres there were statistically significant difference in UKDLIs for transplanted livers (p<0.001) and RNT livers (p=0.024).

Conclusion: Risk factors associated with liver RNT events and variation in risk appetite have been identified. This study can be used to develop strategies to improve liver utilisation in the UK.