Changes in liver allocation in United States.

PURPOSE OF REVIEW: United States has seen several significant changes in liver allocation. The aim of this review is to focus on those changes. RECENT FINDINGS: The success of liver transplantation led to its wider applicability for patients with end-stage liver disease. This success meant ultimately more patients were in need of transplantation, however, there was a limited availability of cadaveric organs. A system of prioritization was critical to reconcile the disparity between supply and demand of organs for liver transplantation. Liver allocation system has continuously evolved since inception. Implementation of the Model for End-Stage Liver Disease (MELD)-system of allocation occurred in 2002. Since then several 'tweaks' have been made to the allocation system. Most recently, United Network for Organ Sharing made significant changes to the liver-allocation policy to promote a broader sharing of livers. This policy eliminates the use of donor service areas (DSAs) and regions, and is consistent with direction given by the US Department of Health and Human Services Final Rule. This policy is awaiting implementation. SUMMARY: An ideal allocation policy would be fair, equitable and significantly reduce the waitlist mortality while simultaneously improving post transplantation outcomes. The impact of the recent changes in liver allocation on landscape of liver transplantation in United States is eagerly awaited.

Safety and Clinical Outcomes of Using Low-Molecular-Weight Dextran During Islet Autotransplantation in Children.

OBJECTIVES: The objective of this study was to evaluate potential safety and clinical benefit of low-molecular-weight dextran (dextran) use in patients undergoing total pancreatectomy with islet auto transplantation (TPIAT). METHODS: We evaluated 124 children undergoing TPIAT at a single institution, either with (n = 72) or without (n = 52) perioperative dextran infusion. Data on islet graft function and postoperative complications were collected through electronic medical records and patient-reported outcomes from research questionnaires. RESULTS: Islet graft failure was less likely at 1 year (odds ratio, 0.186; 95% confidence interval, 0.04-0.65) and 2 years (odds ratio, 0.063; 95% confidence interval, 0.003-0.35) post-TPIAT in the dextran group. This finding remained significant at 2 years in multivariate logistic regression modeling adjusting for islet mass, body surface area, and sex. Likewise, in multivariate regression, the odds of partial islet graft function were higher at 1 and 2 years in the dextran group. Dextran use was overall safe, although it did lead to a higher incidence of postoperative bleeding requiring blood transfusions (P < 0.001). CONCLUSIONS: These findings suggest that dextran use may increase the likelihood for sustained post-TPIAT islet graft function, potentially mitigating severity of postoperative diabetes for these children.