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.
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.
Authors: Andrew D Posner; Samuel T Sultan; Norann A Zaghloul; William S Twaddell; David A Bruno; Steven I Hanish; William R Hutson; Laci Hebert; Rolf N Barth; John C LaMattina Journal: Clin Transplant Date: 2017-07-13 Impact factor: 2.863