Eliza W Beal1, Sylvester M Black2, Khalid Mumtaz3, Don Hayes4, Ashraf El-Hinnawi2, Kenneth Washburn2, Dmitry Tumin5. 1. Division of Transplantation, Department of General Surgery, Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210-1240, USA. Eliza.Beal@osumc.edu. 2. Division of Transplantation, Department of General Surgery, Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210-1240, USA. 3. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. 4. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. 5. Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
Abstract
BACKGROUND: High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. AIMS: It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. METHODS: The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. RESULTS: The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p < 0.001) and, similarly, at centers performing 70 per year (HR 1.35; 95% CI 1.26, 1.43; p < 0.001). The interaction between high donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss. CONCLUSION: At both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.
BACKGROUND: High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. AIMS: It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. METHODS: The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. RESULTS: The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p < 0.001) and, similarly, at centers performing 70 per year (HR 1.35; 95% CI 1.26, 1.43; p < 0.001). The interaction between high donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss. CONCLUSION: At both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.
Authors: Joris J Blok; Andries E Braat; Rene Adam; Andrew K Burroughs; Hein Putter; Nigel G Kooreman; Axel O Rahmel; Robert J Porte; Xavier Rogiers; Jan Ringers Journal: Liver Transpl Date: 2012-01 Impact factor: 5.799
Authors: Deepak K Ozhathil; You Fu Li; Jillian K Smith; Jennifer F Tseng; Reza F Saidi; Adel Bozorgzadeh; Shimul A Shah Journal: Liver Transpl Date: 2011-10 Impact factor: 5.799
Authors: Deepak K Ozhathil; Youfu Li; Jillian K Smith; Jennifer F Tseng; Reza F Saidi; Adel Bozorgzadeh; Shimul A Shah Journal: HPB (Oxford) Date: 2011-06-07 Impact factor: 3.647
Authors: L Adcock; C Macleod; D Dubay; P D Greig; M S Cattral; I McGilvray; L Lilly; N Girgrah; E L Renner; M Selzner; N Selzner; A Kashfi; R Smith; S Holtzman; S Abbey; D R Grant; G A Levy; G Therapondos Journal: Am J Transplant Date: 2010-02 Impact factor: 8.086
Authors: Clifford Akateh; Dmitry Tumin; Eliza W Beal; Khalid Mumtaz; Joseph D Tobias; Don Hayes; Sylvester M Black Journal: Dig Dis Sci Date: 2018-03-24 Impact factor: 3.199
Authors: Clifford Akateh; Rebecca Miller; Eliza W Beal; Dmitry Tumin; Joseph D Tobias; Don Hayes; Sylvester M Black Journal: Dig Dis Sci Date: 2019-07-22 Impact factor: 3.199
Authors: Savio G Barreto; Mark E Brooke-Smith; Eu Ling Neo; Paul Dolan; Richard Leibbrandt; Tim Emery; Robert Carroll; Alan Wigg; John W Chen Journal: Langenbecks Arch Surg Date: 2019-11-20 Impact factor: 3.445
Authors: Matteo Ravaioli; Vanessa De Pace; Andrea Angeletti; Giorgia Comai; Francesco Vasuri; Maurizio Baldassarre; Lorenzo Maroni; Federica Odaldi; Guido Fallani; Paolo Caraceni; Giuliana Germinario; Chiara Donadei; Deborah Malvi; Massimo Del Gaudio; Valentina Rosa Bertuzzo; Antonio Siniscalchi; Vito Marco Ranieri; Antonietta D'Errico; Gianandrea Pasquinelli; Maria Cristina Morelli; Antonio Daniele Pinna; Matteo Cescon; Gaetano La Manna Journal: Sci Rep Date: 2020-04-08 Impact factor: 4.379