Too fatty livers from MS patients not suited for transplantation

Orman ES, et al "The number of grafts available for liver transplantation is decreasing as a result of increasing age, metabolic syndrome, and donation after cardiac death" DDW 2012; Abstract 841.

Dr. Kwong will present these data on Saturday, May 19 at noon PT in Halls C-G of the San Diego Convention Center.

The Number of Grafts Available for Liver Transplantation is Decreasing as a Result of Increasing Donor Age, Metabolic Syndrome and Donation After Cardiac Death (Abstract #841)

The number of liver transplants has declined in the U.S. since 2006, so investigators led by Eric S. Orman, MD, gastroenterology fellow, the University of North Carolina, Chapel Hill, looked at various donor factors to determine why. By studying the United Network for Organ Sharing (UNOS) database for all donor information, researchers assessed which factors prompted physicians to discard an organ. 

With standard donation, a patient is declared brain dead and kept on cardiovascular support so the organs can continue to receive oxygen and blood before being removed for transplant. In recent years, surgeons have also increasingly used the method known as donation after cardiac death, which occurs when patients die and the heart stops on its own. Cardiac death donation is considered an alternative way to donate organs and has been promoted as a way to increase the total number of organ donors. An increasingly large percentage of organ donors are in the donation after cardiac death category; less than 10 years ago, it was fewer than 2 percent, but currently, the rate has increased to more than 12 percent. 

However, there is a widespread pattern of health-care professionals becoming increasingly reluctant to use organs donated after cardiac death. In reviewing the UNOS database, researchers found that the total number of donors who have at least one organ recovered for transplant has stopped increasing over the past few years, despite an increasing proportion of donation after cardiac death donors. 

Investigators looked at the group of organ donors who had at least one organ recovered for transplant to determine whether the donor liver was a fatty liver. By reviewing donor characteristics that are strongly associated with having a fatty liver, such as diabetes, obesity, older age and high blood pressure, researchers found that these factors were all associated with discarding a liver.  “Cardiac death donation is negatively impacting the overall number of liver transplants that we can do,” said Dr. Orman.  

The next step of the research is to look more closely at why more livers are being discarded, how large of a role donation after cardiac death is playing in those organs discarded, and what is driving the increase in donation after cardiac death.  

No pharmaceutical funding was provided for this study.