Skip to main content

Advertisement

SpringerLink
Log in

Liver Transplantation with “Hors Tour” Allocated Versus Standard MELD Allocated Grafts: Single-Center Audit and Impact on the Liver Pool in France

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The French transplant governing system defined “Rescue” (the so-called “Hors Tour”) livers as those livers which were declined for the five top-listed patients. This study compares the outcomes following liver transplantation (LT) in patients who received a donor liver through a rescue allocation (RA) procedure or according to MELD score priority (standard allocation, SA) and evaluates the impact on the graft pool of a proactive policy to accept RA grafts.

Methods

Data from all consecutive patients who underwent LT with SA or RA grafts from 2011 to 2015 were compared in terms of short- and long-term outcomes.

Results

The 249 elective first LTs were performed with 64 (25.7%) RA and 185 (74.3%) SA grafts. RA grafts were obtained from older donors and were associated with a longer cold ischemia time. Recipients of RA livers were older and had lower MELD scores. The rates of delayed graft function, primary nonfunction, retransplantation, complications, and mortality were similar between the RA and SA groups. At 1 and 3 and 5 years, graft and patient survival rates were similar between the groups. These results were maintained after matching on recipient characteristics. Our proactive policy to accept RA grafts increased the liver pool for elective first transplantation by 25%.

Conclusions

RA livers can be safely transplanted into selected recipients and significantly expand the liver pool.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kim WR, Lake JR, Smith JM et al (2017) OPTN/SRTR 2015 annual data report: liver. Am J Transplant 17(Suppl 1):174–251

    Article  Google Scholar 

  2. Eurotransplant International Foundation (2015) In: Branger P, Samuel U (eds) Annual report 2015. Eurotransplant Foundation, Leiden

  3. Agence de la Biomedecine. Annual report 2014. https://www.agence-biomedecine.fr/annexes/bilan2014/donnees/organes/05-foie/pdf/hepatique.pdf

  4. Lopez-Navidad A, Caballero F (2003) Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool. Clin Transplant 17(4):308–324

    Article  Google Scholar 

  5. Durand F, Antoine C, Soubrane O (2019) Liver transplantation in France. Liver Transplant 25(5):763–770

    Article  Google Scholar 

  6. Francoz C, Belghiti J, Castaing D et al (2011) Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system. Liver Transplant 17(10):1137–1151

    Article  Google Scholar 

  7. Jasseron C, Francoz C, Antoine C et al (2019) Impact of the new MELD-based allocation system on waiting list and post-transplant survival—a cohort analysis using the French national CRISTAL database. Transpl Int 32(10):1061–1073

    Article  Google Scholar 

  8. Pezzati D, Ghinolfi D, De Simone P et al (2015) Strategies to optimize the use of marginal donors in liver transplantation. World J Hepatol 7(26):2636–2647

    Article  Google Scholar 

  9. Saidi RF (2013) Utilization of expanded criteria donors in liver transplantation. Int J Organ Transplant Med 4(2):46–59

    PubMed  PubMed Central  Google Scholar 

  10. Sotiropoulos GC, Paul A, Gerling T et al (2006) Liver transplantation with “rescue organ offers” within the eurotransplant area: a 2-year report from the University Hospital Essen. Transplantation 82(3):304–309

    Article  Google Scholar 

  11. Doenecke A, Scherer MN, Tsui TY et al (2010) “Rescue allocation offers” in liver transplantation: is there any reason to reject “unwanted” organs? Scand J Gastroenterol 45(12):1516–1517

    Article  Google Scholar 

  12. Mossdorf A, Kalverkamp S, Langenbrinck L et al (2013) Allocation procedure has no impact on patient and graft outcome after liver transplantation. Transpl Int 26(9):886–892

    Article  CAS  Google Scholar 

  13. Schemmer P, Nickkholgh A, Gerling T et al (2009) Rescue allocation for liver transplantation within Eurotransplant: the Heidelberg experience. Clin Transplant 23(Suppl 21):42–48

    Article  Google Scholar 

  14. Giretti G, Barbier L, Bucur P et al (2018) Recipient selection for optimal utilization of discarded grafts in liver transplantation. Transplantation 102(5):775–782

    Article  Google Scholar 

  15. Ertel AE, Wima K, Hoehn RS et al (2015) Hospital utilization of nationally shared liver allografts from 2007 to 2012. World J Surg 40(4):958–966. https://doi.org/10.1007/s00268-015-3357-1

    Article  Google Scholar 

  16. Halazun KJ, Quillin RC, Rosenblatt R et al (2017) Expanding the margins: high volume utilization of marginal liver grafts among > 2000 liver transplants at a single institution. Ann Surg 266(3):441–449

    Article  Google Scholar 

  17. Marcon F, Schlegel A, Bartlett DC et al (2018) Utilization of declined liver grafts yields comparable transplant outcomes and previous decline should not be a deterrent to graft use. Transplantation 102(5):e211–e218

    Article  Google Scholar 

  18. McCormack L, Quinonez E, Rios MM et al (2010) Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’. HPB (Oxford) 12(8):523–530

    Article  Google Scholar 

  19. Ravaioli M, Grazi GL, Cescon M et al (2009) Liver transplantations with donors aged 60 years and above: the low liver damage strategy. Transpl Int 22(4):423–433

    Article  Google Scholar 

  20. Feng S, Goodrich NP, Bragg-Gresham JL et al (2006) Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 6(4):783–790

    Article  CAS  Google Scholar 

  21. Braat AE, Blok JJ, Putter H et al (2012) The Eurotransplant donor risk index in liver transplantation: ET-DRI. Am J Transplant 12(10):2789–2796

    Article  CAS  Google Scholar 

  22. Dutkowski P, Oberkofler CE, Slankamenac K et al (2011) Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era. Ann Surg 254(5):745–753 discussion 753

    Article  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  24. Olthoff KM, Kulik L, Samstein B et al (2010) Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transplant 16(8):943–949

    Article  Google Scholar 

  25. Lonjon G, Porcher R, Ergina P et al (2016) Potential pitfalls of reporting and bias in observational studies with propensity score analysis assessing a surgical procedure: a methodological systematic review. Ann Surg 265(5):901–909

    Article  Google Scholar 

  26. Vandenbroucke JP, von Elm E, Altman DG et al (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med 147(8):W163–W194

    Article  Google Scholar 

  27. Ravaioli M, Grande G, Di Gioia P et al (2016) Risk avoidance and liver transplantation: a single-center experience in a national network. Ann Surg 264(5):778–786

    Article  Google Scholar 

  28. Adam R, Bismuth H, Diamond T et al (1992) Effect of extended cold ischaemia with UW solution on graft function after liver transplantation. Lancet 340(8832):1373–1376

    Article  CAS  Google Scholar 

  29. Stewart ZA, Locke JE, Segev DL et al (2009) Increased risk of graft loss from hepatic artery thrombosis after liver transplantation with older donors. Liver Transplant 15(12):1688–1695

    Article  Google Scholar 

  30. Knight M, Barber K, Gimson A et al (2012) Implications of changing the minimal survival benefit in liver transplantation. Liver Transplant 18(5):549–557

    Article  Google Scholar 

  31. Schaubel DE, Guidinger MK, Biggins SW et al (2009) Survival benefit-based deceased-donor liver allocation. Am J Transplant 9(4 Pt 2):970–981

    Article  CAS  Google Scholar 

  32. Azoulay D, Audureau E, Bhangui P et al (2016) Living or brain-dead donor liver transplantation for hepatocellular carcinoma: a multicenter, western, intent-to-treat cohort study. Ann Surg 266(6):1035–1044

    Article  Google Scholar 

  33. Battula NR, Platto M, Anbarasan R et al (2017) Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center. Ann Surg 265(5):1009–1015

    Article  Google Scholar 

  34. Toso C, Ris F, Mentha G et al (2002) Potential impact of in situ liver splitting on the number of available grafts. Transplantation 74(2):222–226

    Article  Google Scholar 

  35. Lai JC, Feng S, Roberts JP (2012) An examination of liver offers to candidates on the liver transplant wait-list. Gastroenterology 143(5):1261–1265

    Article  Google Scholar 

  36. Edwards EB, Roberts JP, McBride MA et al (1999) The effect of the volume of procedures at transplantation centers on mortality after liver transplantation. N Engl J Med 341(27):2049–2053

    Article  CAS  Google Scholar 

  37. Mirza DF, Gunson BK, Da Silva RF et al (1994) Policies in Europe on “marginal quality” donor livers. Lancet 344(8935):1480–1483

    Article  CAS  Google Scholar 

  38. Morche J, Mathes T, Pieper D (2016) Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev 5(1):204

    Article  Google Scholar 

  39. Ozhathil DK, Li YF, Smith JK et al (2011) Impact of center volume on outcomes of increased-risk liver transplants. Liver Transplant 17(10):1191–1199

    Article  Google Scholar 

Download references

Acknowledgements

M.D. collected the data, interpreted the data, and wrote the manuscript. A.W. and C.G.G. performed the statistical analysis. H.H. interpreted the data and critically revised the manuscript. C.L. and C.S. interpreted the data and critically revised the manuscript. E.L. interpreted the data and critically revised the manuscript. C.F. interpreted the data and critically revised the manuscript. D.A. conceived the study, interpreted the data, and revised the manuscript. P.C. designed the study, interpreted the data, and wrote the manuscript.

Author information

Authors and Affiliations

  1. Centre Hépato-Biliaire, Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Avenue Paul Vaillant Couturier, 94000, Villejuif, France

    Daniel Azoulay & Chady Salloum

  2. Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel Azoulay

  3. Department of Hepatobiliary Surgery and Transplantation, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France

    Mara Disabato, Norbert Ngonggang, Hassen Hentati & Philippe Compagnon

  4. Department of Hépato-Pancreato-Biliary and Transplant Surgery, Vall d’Hébron University Hospital, Barcelona, Spain

    Concepcion Gomez-Gavara

  5. Department of Hepatology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Villejuif, France

    Cyrille Feray

  6. Laboratoire de Biostatistique, IURC, Montpellier, France

    Audrey Winter

  7. Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, Créteil, France

    Eric Levesque

  8. Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Chetana Lim

  9. Service de Transplantation, Hôpitaux Universitaires de Genève, Université de Genève, Faculté de Médecine, Geneva, Switzerland

    Philippe Compagnon

Authors
  1. Daniel Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mara Disabato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Concepcion Gomez-Gavara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cyrille Feray
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chady Salloum
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norbert Ngonggang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Audrey Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hassen Hentati
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eric Levesque
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chetana Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Philippe Compagnon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Azoulay.

Ethics declarations

Conflict of interest

The authors of this manuscript have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azoulay, D., Disabato, M., Gomez-Gavara, C. et al. Liver Transplantation with “Hors Tour” Allocated Versus Standard MELD Allocated Grafts: Single-Center Audit and Impact on the Liver Pool in France. World J Surg 44, 912–924 (2020). https://doi.org/10.1007/s00268-019-05271-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05271-w

Search

Navigation