Elsevier

Transplantation Proceedings

Volume 42, Issue 6, July–August 2010, Pages 2327-2330
Transplantation Proceedings

Liver transplantation
Outcome of Liver Transplantation Based on Donor Graft Quality and Recipient Status

https://doi.org/10.1016/j.transproceed.2010.05.018Get rights and content

Abstract

Background

Availability of suitable donor organs has always limited the number of liver transplantations performed. Use of marginal donor organs is an alternative to overcome organ shortage.

Objective

To analyze the effect of various combinations of donor organ quality and recipient status on the outcome of liver transplantation.

Materials and Methods

Data from 260 whole-liver transplantations performed between January 2003 and September 2009 were analyzed retrospectively. Study groups were established according to donor organ quality (marginal score 0–1 vs 2–5) and recipient status (Model for End-Stage Liver Disease [MELD] score <17 or >17). In patients at low risk, 102 received optimal grafts (good-to-good group [G/G], and 75 received marginal grafts (bad-to-good group [B/G]. In patients at high risk, 46 received optimal grafts (good-to-bad group [G/B], and 37 received marginal grafts (bad-to-bad group [B/B].

Results

No differences were observed in cumulative patient and graft survival rates; however, total survival differed in the early period after transplantation, that is, within 1 year. There was a higher rate of overall postoperative complications including initial poor graft function, bleeding, infection, and kidney failure in group B/B compared with group G/B (25 of 37 patients [67.5%] vs 27 of 46 patients [59.0%]), group B/G (25 of 37 patients [68%] vs 39 of 75 patients [52%], and group G/G (25 of 37 patients [68%] vs 43 of 102 patients [42%]) (P = .04). Patients with a high MELD score (G/B and B/B) demonstrated increased risk of postoperative complications. Use of donor organs with marginal score of 2 or higher in patients with high MELD scores increased early patient mortality.

Conclusion

In summary, patients with a high MELD score (G/B and B/B) are at an increased risk of post-OLT complications. In contrast, use of marginal grafts (B/G and B/B) increased the rate of hepatitis C virus recurrence and decreased the response rate to antiviral therapy. The combination of impaired donor grafts and recipients at high risk should be avoided.

Section snippets

Materials and Methods

From January 2003 to September 2009, 260 whole-liver transplantation procedures were performed at our center. The study groups were established according to donor graft quality and recipient status. Based on our previous study,9 donors had a marginal score of 1 if any of the following were present: age older than 60 years, body mass index greater than 27, intensive care unit stay longer than 3 days, high inotropic support including dopamine dose more than 10 μg/kg/min or need for combined

Results

There were 102 patients in group G/G (39%), 75 in group B/G (29%), 46 in group G/B (17.7%), and 37 in group B/B (14%). Recipient age, sex, cold and warm ischemia times, operating time, and indication for OLT were comparable in the studied groups (data not shown). There was no significant difference in cumulative patient and graft survival rates. Respective 1-, 3-, and 5-year patient survival rates were 93%, 86%, and 83% in group G/G; 84%, 79%, and 75.5% in group B/G; 82%, 79%, and 72% in group

Discussion

In the last 15 years, a substantial source of cadaver grafts has been marginal donors including those with obesity, high serum sodium concentration, increased transaminase concentrations, hemodynamic instability, or needing inotropic support.1, 2, 3 Because of our strict exclusion criteria for donors, our OLT results have been good. However, an increasing number of patients are awaiting liver transplantation. Similar to other studies,4, 5 we did not observe worse outcomes of OLT using marginal

References (20)

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