Primary Team Versus Local Recovery in Liver Transplantation in the Modern Era: A National Analysis of the United Network for Organ Sharing Database.

Autor: Whitrock JN; Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Sisak S; Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Pratt CG; Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Delman AM; Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Price AD; Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Wima K; Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Shah SA; Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Quillin RC 3rd; Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Aug; Vol. 38 (8), pp. e15418.
DOI: 10.1111/ctr.15418
Abstrakt: Background: The implementation of acuity circles (AC) in 2020 and the COVID-19 pandemic increased the use of local surgeons to recover livers for transplant; however, the impact on liver transplant (LT) outcomes is unknown.
Methods: Deceased donor adult LT recipients from the UNOS database were identified.  Recipients were grouped by donor surgeon: local versus primary recovery.  Patient and graft survival as well as trends in local recovery in the 2 years pre-AC and post-AC were assessed.
Results: The utilization of local recovery in LT increased from 22.3% to 37.9% post-AC (p < 0.01).  LTs with local recovery had longer cold ischemia times (6.5 h [5.4-7.8] vs. 5.3 h [4.4-6.5], p < 0.01) and traveled further (210 miles [89-373] vs. 73 miles [11-196], p < 0.01) than those using primary recovery. Multivariate analyses revealed no differences in patient or graft survival between local and primary recovery, and between OPO and local surgeon. There was no difference in survival when comparing simultaneous liver-kidney, donation after circulatory death, MELD ≥ 30, or redo-LT by recovery team.  Recovery and utilization rates were also noted to be higher post-AC (51.4% vs. 48.6% pre-AC, p < 0.01) as well as when OPO surgeons recovered the allografts (72.5% vs. 66.0%, p < 0.01).
Conclusion: Nearly 40% of LTs are performed using local recovery, and utilization rates and trends continue to change with changing organ-sharing paradigms such as AC.  This practice appears safe with outcomes similar to recovery by the primary team in appropriately selected recipients and may lead to increased access and the ability to transplant more livers.
(© 2024 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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