Allocation procedure has no impact on patient and graft outcome after liver transplantation

Abstract

Summary The aim of our study was to compare the postoperative outcome after liver transplantation (LT) in patients who received a donor liver via standard or rescue allocation (RA). Special emphasize was laid on the effect extended donor criteria might have on the outcome. One hundred and ten LTs have been performed at the University Hospital Aachen, Germany. A total of 49 patients were included in the standard allocation (SA) group and 53 patients in the RA group. The outcome of LT in both groups was evaluated by the length of stay on the intensive care unit (ICU), duration of hospitalization, 1‐year patient survival, 1‐year graft survival, incidence of primary nonfunction and major complications. Patients in group RA had a significant shorter ICU and overall hospital stay. The 1‐year graft survival was 87.8% in group SA and 88.7% in group RA. The 1‐year patient survival was 87.9% in group SA and 96.2% in group RA. The number of re‐LT was 2% in group SA and 7.5% in group RA. Organs that were rejected for transplantation several times can successfully be transplanted through the RA procedure, thereby enlarging the donor pool without negative effects on the quality of LT.

The Differential Influence of Cold Ischemia Time on Outcome After Liver Transplantation for Different Indications—Who Is at Risk? A Collaborative Transplant Study Report

“…Therefore, entering the indication for transplantation and CIT as categorical variable for HCC and for alcoholic cirrhosis with 3 different categories (HCC: <10 h, 10-13 h, and ≥14 h; alcoholic cirrhosis: <12 h, ≥12 h), and their respective coefficients may be worth considering as it might increase the specificity of the DRIs. The allocation process is complex, but CIT can be managed by improved internal organization and regional allocation if estimated cold ischemia exceeds certain limits (2,27). Our study of more than 40,000 patients revealed a strong negative linear impact of CIT on 1-year graft and patient survival.…”

Donor selection criteria for liver transplantation in Argentina: are current standards too rigorous?

“…The use of extended criteria donors can be associated with higher rates of primary non‐function. This complication occurs in 5.8–9% in the largest series reported . In this analysis, the prevalence of primary non‐function was quite low, 3.4%, as well as early post‐transplant mortality (5.2%) probably related to the preferential selection of good or even ideal donors.…”

Should we use liver grafts repeatedly refused by other transplant teams?

“…In the Eurotransplant group, after 3 refusals a graft is qualified as a rescue allocation. In this context, the studies by Doenecke et al, 5 Schemmer et al 6 and Mossdorf et al, 7 performed in small groups of patients, did not reveal any significant difference in survival between CA and PA. Indeed, in Eurotransplant, more than 20% of LTs are considered as CA, whereas in France this subpopulation only accounts for 6% of LTs.…”

“…Five series with a restrictive number of patients relative to this CA strategy have been reported. [5][6][7][8][9] In the face of liver shortages, our aim was to determine whether the survival of CA recipients/grafts was worse than that of PA recipients/grafts, taking account of selection bias. Furthermore, we explored the survival benefit offered by CA grafts by comparing grafting a patient with a CA graft without delay rather than remaining on the waiting list and possibly receiving a PA graft at a later point.…”

“…Five series with a restrictive number of patients relative to this CA strategy have been reported. [5] , [6] , [7] , [8] , [9] …”