Identification of new donor variables associated with graft survival in a single-center liver transplant cohort (original) (raw)
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Donor Liver Dysfunction: Application of a New Scoring System to Identify the Marginal Donor
Transplantation Proceedings, 2007
Livers from marginal donors are increasingly used for transplantation due to the shortage of donor organs. The definition of a marginal donor remains unclear; prediction of organ function is a challenge. In the literature the use of steatotic livers has been associated with poor liver function or even primary dysfunction of the allograft. Tekin et al created a scoring system that classifies a donor as marginal or nonmarginal, using a mathematical model based on donor age and steatosis degree. The aims of this study were to apply the Tekin method to identify marginal and nonmarginal donors and evaluate the influence of the cold ischemia time (CIT) on allograft evolution. We retrospectively reviewed deceased donor liver transplantations performed from October 1995 to March 2006, namely, 177 adult liver transplantations in 163 patients. Fifty-five were excluded due to retransplantation (14) or insufficient data (41). Donor age and macrovesicular steatosis were evaluated according to the mathematical formula proposed by Tekin et al, classifying the donors as marginal versus nonmarginal. The authors also analyzed the CIT, 3-month mortality, and development of primary nonfunction or primary dysfunction. The median donor age was 38.9 years (range, 6–71). The postreperfusion biopsy specimen showed moderate to intense steatosis (>30%) in 14.75% of specimens, with no steatosis or mild steatosis in 85.25%. Sixty-one grafts (50%) developed primary graft dysfunction (PGD): 10 grafts, with primary nonfunction (PNF); and 51 with initial poor function (IPF). Using the criteria provided by Tekin et al, we obtained 41 marginal and 81 nonmarginal allografts. The marginal group showed 61.9% PGD, compared with 59.2% of PGD by the nonmarginal group. The CIT was greater than 12 hours in 5 marginal group transplants and 4 PGD cases (80%). Of the nonmarginal allografts, the CIT was greater than 12 hours in 29.6%, with 75% PGD. The 3-month graft survival rate was 80% in the marginal group with ischemia time more than 12 hours: 86.1% of the same group when CIT was less than 12 hours, and 82.7% in the nonmarginal group. In contrast, when we analyzed the occurrance of allograft dysfunction, the 3-month mortality rate was 34% among, grafts with dysfunction, whereas, in those without initial dysfunction, it was 4.1%. In conclusion, the score suggested by Tekin et al that classifies the donors as ideal (nonmarginal) or marginal was not able to predict initial primary dysfunction.
Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index
American Journal of Transplantation, 2006
Transplant physicians and candidates have become increasingly aware that donor characteristics significantly impact liver transplantation outcomes. Although the qualitative effect of individual donor variables are understood, the quantitative risk associated with combinations of characteristics are unclear. Using national data from 1998 to 2002, we developed a quantitative donor risk index. Cox regression models identified seven donor characteristics that independently predicted significantly increased risk of graft failure. Donor age over 40 years (and particularly over 60 years), donation after cardiac death (DCD), and split/partial grafts were strongly associated with graft failure, while African-American race, less height, cerebrovascular accident and 'other' causes of brain death were more modestly but still significantly associated with graft failure. Grafts with an increased donor risk index have been preferentially transplanted into older candidates (>50 years of age) with moderate disease severity (nonstatus 1 with lower model for end-stage liver disease (MELD) scores) and without hepatitis C. Quantitative assessment of the risk of donor liver graft failure using a donor risk index is useful to inform the process of organ acceptance.
Transplantation Proceedings, 2006
Background. It remains unclear which donor and recipient factors influence long-term allograft function in lung transplantation (LTx). Methods. From October 1988 to February 2005, a total of 280 recipients underwent LTx at our center. Donor data and cause of death (CoD) were analyzed. The CoD was categorized according to rate of increase in intracranial pressure at the time of death. Each donor and recipient factor was correlated with long-term graft function. Recipient details, type of transplant, indication for transplant, and time on waiting list were analyzed. Recipients were stratified based on allograft ischemia time (AIT): 0 to 6, 6 to 8, 8 to 10, and Ͼ10 hours. Results. Mean donor age was 30.9 years (36.7% male); 49.8% were cytomegalovirus (CMV) positive. Donor CoD was characterized by a slow rise in intracranial pressure (ICP) in 34.4%, rapid ICP in 18.7%, an intermediate ICP in 44.3%, and with no rise in 2.6%. A graft survival benefit was seen with female donors (P ϭ .048); 34.4% of recipients ultimately developed graft failure at long term follow-up. Mean recipient age was 48 years; 63% were male and mean body-mass index (BMI) was 23.6; 60.2% had single lung transplantation, and mean wait list time was 323 days. Mean AIT totaled 421 minutes. Graft survival was longer with AIT of 8 to 10 hours compared to 6 to 8 hours (P ϭ .03). Conclusions. Donor factor analysis implied only female donor status conferred a long-term graft survival advantage. Intracranial pressure rise differences appear clinically unimportant. Prolonged cold ischemic time (Ͼ10 hours) or low recipient BMI did not adversely affect allograft function in our review.
Extremely Marginal Liver Grafts From Deceased Donors Have Outcome Similar to Ideal Grafts
Background. Although there is a worldwide need to expand the donor pool, many cadaveric marginal livers are usually discarded for transplantation. Herein, we report the outcome of a series of patients receiving marginal grafts. Methods. We analyzed all patients who underwent liver transplantation in our unit from August 2006 to March 2011 (n 125) with the use of a prospectively collected database. Patients with 3 of donor (prolonged hypotensive episodes, donor age 55 years, high vasopressor drug requirement, hypernatremia, prolonged intensive care unit stay, elevated transaminases) and graft-related (cold ischemia 12 hours, warm ischemia time 40 minutes and steatosis 30%) extended criteria were defined as extremely marginal liver grafts (EMLG). The outcomes of patients receiving EMLG were compared with the recipients of grafts without any marginal criteria (ideal grafts). Results. The EMLG group (n 36) showed higher operative transfusion requirement (66.6% vs 55.6%) as well as 30-day (11.1% vs 55%) and 1-year (22.2% vs 5.5%) mortality rates, compared with the ideal grafts group (n 18) but without a significant difference. Other variables, such as major complications, postoperative hemodialysis, ICU and hospital stay, and 1-year survival also were not significantly different. Conclusions. The liver pool can be safely expanded using EMLG from deceased donors for liver transplantation. These usually discarded liver grafts showed similar early and long-term outcomes compared with ideal organs.
Evaluation of potential liver donors: limits imposed by donor variables in liver transplantation
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2003
The aim of this study was to evaluate the predictive value of different donor and recipient parameters that have been recognised previously as proven and to suggest prognostic factors for immediate liver function and final outcome after liver transplantation. We evaluated a total of 228 liver grafts transplanted in the last 3 years in our institution. Parameters were recorded for the donor (age, polytransfusion, atherosclerosis, presence of infection, episodes of hypoxia or hypotension, use of vasoactive drugs, intensive care unit stay, steatosis, and ischemia time) and recipient (red blood cell requirements, immediate liver function [score], incidence of hepatic artery thrombosis, survival, and cause of death or retransplantation). Liver biopsy after reperfusion of the donor liver was performed before closure of the abdomen. Donor age over 65 years and presence of steatosis were associated significantly with initial poor function. The mortality rate at 6 months was related to donor...
Graft Related Factors Affecting the Recipient Outcome in Living Donor Liver Transplantation
The Medical Journal of Cairo University, 2019
Background: Multiple risk factors have been incriminated in poor outcome and survival after Living Donor Liver Transplantation (LDLT). We conducted this study to identify graftrelated factors that affects recipient outcome and survival after LDLT. Patients and Methods: This is a combined retrospective and prospective study that was conducted at Mansoura University Gastrointestinal Surgical Center GISC. We included 460 transplant recipients in the period between June 2004 and July 2016. Moreover, the prospective arm included 50 patients who underwent living donor liver transplantation as a sample size from starting the study in July 2016. After careful preoperative preparation for both donor and recipient, cases were scheduled for living donor liver transplantation. All cases were performed by the same transplant surgical team using the standard surgical procedure. After procedure, patients were transferred to the liver transplant ICU for 1 week, then to the liver high care unit. In addition to clinical evaluation, follow-up of the recipients was performed by laboratory and radiological investigations. Evaluation of the liver by abdominal CT was routinely performed 2 to 3 times over the first year after LT, and then once or twice per year. Results: It was evident that acute rejection was associated with shorter cold ischemia time (31.84 vs. 42.58 minutes-p=0.016). Moreover, larger biliary stoma size was also associated with acute rejection (4.24 vs. 3.73mm-p=0.045). Regarding bile leakage, it was found to be associated with smaller hepatic venous reconstruction diameter (26.11 vs. 27.38mm-p=0.036). Additionally, it was found that incidence of biliary strictures was associated with longer warm ischemia time (51.85 vs. 45.32 minutes-p=0.019), smaller vs venous reconstruction diameter (7.41 vs. 8.52-p=0.024), and smaller biliary reconstruction diameter (3.51 vs. 3.84mm-p=0.033). Cases who developed primary graft dysfunction were having significantly prolonged warm ischemia time (66.92 vs. 46.52 minutes-p 0.011). Chronic graft rejection was associated with larger Makuuchi vein reconstruction diameter (13.40 vs. 9.62mm-p=0.020). However, other graft related factors did not seem to be different between cases who developed and who did not develop chronic rejection.