studies

628A AASLD ABSTRACTS HEPATOLOGY, October, 2015
safety improvements for these patients. Historically, in-depth
reviews of medical records were needed to identify AEs, usually
prompted by a sentinel event. This is very time-consuming,
requiring a high level of skill and resources. The IHI Global
Trigger Tool (GTT) helps identify AEs more efficiently, but lacks
clarity of definitions of complications and guidance for meaningful
interpretation. We developed a modified GTT to improve
precision and is simple to use for review of every LD at LDLT
programs. METHODOLOGY: Medical records were collected
from 4 Adult to Adult Living Donor Liver Transplantation Cohort
Study (A2ALL) centers from 2008-2010. Records included all
documents from admission to discharge and any readmission
within 30 days after LDLT. A multidisciplinary team (transplant
surgeon, physician scientist, nurses, and medical student) modified
the GTT to include transplant specific AEs and created evidence-based
precise clinical definitions of outcomes, compiled
into a codebook. Records were analyzed by two reviewers.
RESULTS: 91 living donor medical records were reviewed. The
mean age was 39. 57% were male, 77% were Caucasian,
19% were Hispanic or black, 93% were English speaking.
722 AEs were identified in 91 records (mean 7.8/patient
(2-19)). 29% had 5-7 AEs and 14% had 12-14 AEs. The ten
most frequent AEs were: nausea (68%), constipation (67%),
hypoxia (64%), anemia (46%), respiratory depression (46%),
tachypnea (46%), hypotension (42%), atelectasis (41%), pleural
effusion (41%), fever (37%). With the enhanced GTT, the
time per for each review was 60 min. Inter-rater reliability was
> 0.9. DISCUSSION: AEs are far more prevalent than reported
to date and can highlight areas requiring improvement before
a sentinel event occurs. The enhanced GTT is a simple and
efficient tool to identify AE in all living liver donors performed
a LDLT center and it can be reliably used by anybody (e.g.
coordinator) after minimal training.
Disclosures:
James V. Guarrera - Grant/Research Support: Organ Recovery Systems
The following authors have nothing to disclose: Blake Platt, Donna Woods, Amna
Daud, Elizabeth A. Pomfret, Mary Ann Simpson, Robert A. Fisher, Anton I. Skaro,
Timothy Curtis, Ella F. Reyes, Erin Wymore, Daniela Ladner
844
Older Liver Transplant (LT) Candidates with Prolonged
Wait-Times Have a Low Probability of LT
Connie W. Wang, Jennifer C. Lai; University of California, San
Francisco, San Francisco, CA
Background: The growing wave of older adults with cirrhosis
has increased demand for LT in ≥65 year(y) olds. While the
decision to list a patient(pt) for LT may initially be straightforward,
this decision is particularly dynamic for pts ≥65y who
are vulnerable to the effects of aging, comorbidities, and even
decreasing motivation for surgery over time. We aimed to evaluate
the probability of LT over time among ≥65y pts. Methods:
All US adult LT candidates listed without MELD exception
points from 2/02-2/12 were categorized by wait-times