The fate of donor livers allocated via an out-of-sequence expedited placement (EP) pathway has not been previously examined. We determined the originating and receiving United Network for Organ Sharing (UNOS) regions of all donor livers procured between January 1, 2010 and October 31, 2012 and placed out of sequence with UNOS bypass code 863 (EP attempt) or 898 (miscellaneous). We reviewed the early function of these liver grafts and assessed the effect of EP allocation on wait-listed patients at our center. Registrants at our center were eligible to receive 1298 liver offers during the interval studied: 218 (16.8%) of these liver offers bypassed our center and were allocated to other centers and used in patients lower on the match-run list. During the study interval, 560 livers were allocated in the United States by EP. Regions 1, 5, 7, 9, and 10 used the greatest number of EP-placed grafts. Region 1 (New England) used the greatest proportion of all EP livers (33% of all imported EP livers in the United States, P < 0.001 versus all other regions). Graft function data were available for 560 livers placed by EP: 491 (88%) of these grafts were functioning at a mean of 399.5 days after transplantation. In conclusion, the transplantation of livers allocated by means of an expedited refusal code is asymmetric across regions and, in some instances, results in the bypassing of patients with higher wait-list priority but without notification of the bypassed center. Short-term graft function after EP allocation is excellent. Policies governing EP allocation should be created in order to improve access to available organs.

The purpose of this study was to investigate the safety and efficacy of three-dimensional spiral computed tomoangiography (3-D spiral CTA) of the abdomen as a substitute for renal angiography in the evaluation of potential live kidney donors. Two of 10 potential live renal donors underwent 3-D spiral CTA only, whereas the remaining 8 underwent 3-D spiral CTA and renal angiography before transplantation. 3-D spiral CTA and renal angiography results were compared and correlated with intraoperative findings. In all 8 cases in which 3-D spiral CTA and renal angiography were compared, the number of arteries was correctly identified by both modalities. In this limited study, 3-D spiral CTA provided the same information as did angiography. According to these findings, 3-D spiral CTA might be used as an alternative to renal angiography, though a larger series is needed to determine whether it could replace renal angiography for all potential live-donor work-ups.

The purpose of this study was to investigate the safety and efficacy of three-dimensional spiral computed tomoangiography (3-D spiral CTA) of the abdomen as a substitute for renal angiography in the evaluation of potential live kidney donors. Two of 10 potential live renal donors underwent 3-D spiral CTA only, whereas the remaining 8 underwent 3-D spiral CTA and renal angiography before transplantation. 3-D spiral CTA and renal angiography results were compared and correlated with intraoperative findings. In all 8 cases in which 3-D spiral CTA and renal angiography were compared, the number of arteries was correctly identified by both modalities. In this limited study, 3-D spiral CTA provided the same information as did angiography. According to these findings, 3-D spiral CTA might be used as an alternative to renal angiography, though a larger series is needed to determine whether it could replace renal angiography for all potential live-donor WOrk-ups.