OBJECTIVE: Severely limited organ resources mandate maximum utilization of donor allografts for orthotopic liver transplantation (OLT). This work aimed to identify factors that impact survival outcomes for extended criteria donors (ECD) and developed an ECD scoring system to facilitate graft-recipient matching and optimize utilization of ECDs. METHODS: Retrospective analysis of over 1000 primary adult OLTs at UCLA. Extended criteria (EC) considered included donor age (>55 years), donor hospital stay (>5 days), cold ischemia time (>10 hours), and warm ischemia time (>40 minutes). One point was assigned for each extended criterion. Cox proportional hazard regression model was used for multivariate analysis. RESULTS: Of 1153 allografts considered in the study, 568 organs exhibited no extended criteria (0 score), while 429, 135 and 21 donor allografts exhibited an EC score of 1, 2 and 3, respectively. Overall 1-year patient survival rates were 88%, 82%, 77% and 48% for recipients with EC scores of 0, 1, 2 and 3 respectively (P < 0.001). Adjusting for recipient age and urgency at the time of transplantation, multivariate analysis identified an ascending mortality risk ratio of 1.4 and 1.8 compared to a score of 0 for an EC score of 1, and 2 (P < 0.01) respectively. In contrast, an EC score of 3 was associated with a mortality risk ratio of 4.5 (P < 0.001). Further, advanced recipient age linearly increased the death hazard ratio, while an urgent recipient status increased the risk ratio of death by 50%. CONCLUSIONS: Extended criteria donors can be scored using readily available parameters. Optimizing perioperative variables and matching ECD allografts to appropriately selected recipients are crucial to maintain acceptable outcomes and represent a preferable alternative to both high waiting list mortality and to a potentially futile transplant that utilizes an ECD for a critically ill recipient.
OBJECTIVE: Severely limited organ resources mandate maximum utilization of donor allografts for orthotopic liver transplantation (OLT). This work aimed to identify factors that impact survival outcomes for extended criteria donors (ECD) and developed an ECD scoring system to facilitate graft-recipient matching and optimize utilization of ECDs. METHODS: Retrospective analysis of over 1000 primary adult OLTs at UCLA. Extended criteria (EC) considered included donor age (>55 years), donor hospital stay (>5 days), cold ischemia time (>10 hours), and warm ischemia time (>40 minutes). One point was assigned for each extended criterion. Cox proportional hazard regression model was used for multivariate analysis. RESULTS: Of 1153 allografts considered in the study, 568 organs exhibited no extended criteria (0 score), while 429, 135 and 21 donor allografts exhibited an EC score of 1, 2 and 3, respectively. Overall 1-year patient survival rates were 88%, 82%, 77% and 48% for recipients with EC scores of 0, 1, 2 and 3 respectively (P < 0.001). Adjusting for recipient age and urgency at the time of transplantation, multivariate analysis identified an ascending mortality risk ratio of 1.4 and 1.8 compared to a score of 0 for an EC score of 1, and 2 (P < 0.01) respectively. In contrast, an EC score of 3 was associated with a mortality risk ratio of 4.5 (P < 0.001). Further, advanced recipient age linearly increased the death hazard ratio, while an urgent recipient status increased the risk ratio of death by 50%. CONCLUSIONS: Extended criteria donors can be scored using readily available parameters. Optimizing perioperative variables and matching ECD allografts to appropriately selected recipients are crucial to maintain acceptable outcomes and represent a preferable alternative to both high waiting list mortality and to a potentially futile transplant that utilizes an ECD for a critically ill recipient.
Authors: E Totsuka; F Dodson; A Urakami; N Moras; T Ishii; M C Lee; J Gutierrez; M Gerardo; E Molmenti; J J Fung Journal: Liver Transpl Surg Date: 1999-09
Authors: Ronald W Busuttil; Douglas G Farmer; Hasan Yersiz; Jonathan R Hiatt; Sue V McDiarmid; Leonard I Goldstein; Sammy Saab; Steven Han; Francisco Durazo; Michael Weaver; Carlos Cao; Tony Chen; Gerald S Lipshutz; Curtis Holt; Sherilyn Gordon; Jeffery Gornbein; Farin Amersi; Rafik M Ghobrial Journal: Ann Surg Date: 2005-06 Impact factor: 12.969
Authors: Nicholas N Onaca; Marlon F Levy; Edmund Q Sanchez; Srinath Chinnakotla; Carlos G Fasola; Mark J Thomas; Jeffrey S Weinstein; Natalie G Murray; Robert M Goldstein; Goran B Klintmalm Journal: Liver Transpl Date: 2003-02 Impact factor: 5.799
Authors: Marina Berenguer; Martín Prieto; Fernando San Juan; José M Rayón; Fernando Martinez; Domingo Carrasco; Angel Moya; Francisco Orbis; José Mir; Joaquín Berenguer Journal: Hepatology Date: 2002-07 Impact factor: 17.425
Authors: Rafik M Ghobrial; Jeffery Gornbein; Randy Steadman; Natale Danino; James F Markmann; Curtis Holt; Dean Anselmo; Farin Amersi; Pauline Chen; Douglas G Farmer; Steve Han; Francisco Derazo; Sammy Saab; Leonard I Goldstein; Sue V McDiarmid; Ronald W Busuttil Journal: Ann Surg Date: 2002-09 Impact factor: 12.969
Authors: J Figueras; J Busquets; L Grande; E Jaurrieta; J Perez-Ferreiroa; J Mir; C Margarit; P Lopez; J Vazquez; D Casanova; A Bernardos; E De-Vicente; P Parrilla; J M Ramon; R Bou Journal: Transplantation Date: 1996-02-15 Impact factor: 4.939