Liver biopsy in assessment of extended criteria donors

Introduction: The safety and liver utilization with prerecovery liver biopsy (PLB) in extended criteria liver donors are unclear. Methods: We conducted a retrospective cohort study in 1323 brain death donors (PLB=496) from three organ procurement organizations (OPOs). Outcomes were complications, preemption of liver recovery (PLR) and livers transplanted (LT). Additional analyses included liver only and propensity score-matched multiorgan donor subgroups. Results: PLB donors were older (57yrs vs 53yrs, p<0.001). Hepatitis CAb positivity (14.3% vs 9.6%, p=0.01), and liver-only donors (42.6% vs 17.5%, p<0.001) were more prevalent. PLB cohort had fewer complications (31.9% vs 42.3%, p<0.001). In PLB cohort, PLR was significantly higher (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.42-4.92]) and LT lower (0.69 [95% CI 0.52-0.91]). In liver only and propensity score-matched multiorgan donor subgroups, PLR was significantly higher (OR 1.76 [95% CI 1.06-2.94]) and (2.29 [95% CI 1.37-3.82], respectively without a decrease in LT (OR 0.71 [95% CI 0.43-1.18]) and (0.91 [95% CI 0.63-1.33]), respectively in PLB subgroups. Conclusion: In extended criteria liver donors, PLB is safe and decreases futile liver recovery without decreasing LT. Increased use of PLB, especially in liver only donors is likely to save costs to OPOs and transplant centers and improve efficiencies in organ allocation. This article is protected by copyright. All rights reserved.