Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index

Feng, Sandy; Goodrich, Nathan P.; Bragg-Gresham, J. L.; Dykstra, Dawn M.; Punch, Jeffrey D.; DebRoy, Meelie; Greenstein, Stuart; Merion, Robert M.

doi:10.1111/j.1600-6143.2006.01242.x

Cited by 1,711 publications

(1,847 citation statements)

References 38 publications

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“…Among the intraoperative variables, no difference was noted with respect to the length of the operative time, cold ischemic time, number of packed red blood cells transfused, or use of biliary drainage tubes (t-tubes). The DRI, a calculated value proposed by Feng et al in 2006, 14 incorporates donor and operative variables to assess the risk of graft failure after OLT. We examined this value as an overall marker of donor organ quality to determine if it would have an impact on the development of BCS.…”

Section: Discussionmentioning

confidence: 99%

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

et al. 2008

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Biliary cast syndrome (BCS), the presence of biliary casts and debris causing biliary obstruction, occurs in 4%-18% of orthotopic liver transplant (OLT) recipients. Potential consequences include cholangitis and graft damage or loss. Limited data exist regarding the etiology and outcomes of BCS. The purpose of this study was to evaluate donor and recipient risk factors and determine the impact of BCS. A retrospective review of 355 OLT cases identified 9 BCS patients (2.5%) diagnosed by cholangiography. Twenty-six matched controls were also identified. The warm ischemic time was significantly longer in BCS patients. Other recipient and donor preoperative and intraoperative characteristics, including the donor risk index, revealed no significant differences. Overall patient survival showed a trend toward worse outcomes at 6, 12, and 18 months and end of follow-up in the BCS group. Overall graft survival was also worse in the BCS group at all time periods, with statistical significance demonstrated at 18 months and end of follow-up. The number of therapeutic biliary procedures and hospital readmissions was significantly higher in the BCS group. Twenty-two percent of the BCS patients required repeat OLT versus none of the control patients. In conclusion, BCS is an uncommon complication of OLT. Except for a longer warm ischemic time, recipient and donor factors did not predict the occurrence of BCS. BCS patients showed a significantly worse graft survival, as well as a trend toward worse patient survival. Given the negative impact of BCS on liver transplant outcomes, further studies appear justified.

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Section: Discussionmentioning

confidence: 99%

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

et al. 2008

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“…17,18 For the DCD organ procurement, a rapid retrieval technique was used in which the abdomen was opened with a cruciate incision. The small bowel was reflected superiorly, and the aorta and portal systems were cannulated for an in situ flush.…”

Section: Methodsmentioning

confidence: 99%

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

et al. 2014

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Donation after cardiac death (DCD) liver allografts have been associated with increased morbidity from primary nonfunction, biliary complications, early allograft failure, cost, and mortality. Early allograft dysfunction (EAD) after liver transplantation has been found to be associated with inferior patient and graft survival. In a cohort of 205 consecutive liver-only transplant patients with allografts from DCD donors at a single center, the incidence of EAD was found to be 39.5%. The patient survival rates for those with no EAD and those with EAD at 1, 3, and 5 years were 97% and 89%, 79% and 79%, and 61% and 54%, respectively (P 5 0.009). Allograft survival rates for recipients with no EAD and those with EAD at 1, 3, and 5 years were 90% and 75%, 72% and 64%, and 53% and 43%, respectively (P 5 0.003). A multivariate analysis demonstrated a significant association between the development of EAD and the cold ischemia time [odds ratio (OR) 5 1.26, 95% confidence interval (CI) 5 1.01-1.56, P 5 0.037] and hepatocellular cancer as a secondary diagnosis in recipients (OR 5 2.26, 95% CI 5 1.11-4.58, P 5 0.025). There was no correlation between EAD and the development of ischemic cholangiopathy. In conclusion, EAD results in inferior patient and graft survival in recipients of DCD liver allografts. Understanding the events that cause EAD and developing preventive or early therapeutic approaches should be the focus of future investigations. Liver Transpl 20:1447-1453, 2014. V C 2014 AASLD.Received March 28, 2014; accepted August 7, 2014.The success of liver transplantation (LT) has expanded its therapeutic utility and necessitated the increased use of marginal donors to meet the growing demand. To understand the impact of these marginal organs, a clinical tool for identifying early allograft dysfunction (EAD) has been previously described by multiple groups. 1-4 A simple definition (characterized by high early aminotransferase levels, persistent cholestasis, and prolonged coagulopathy in the first week after LT) has previously been validated in a multicenter retrospective review of 297 LT recipients of liver allografts from both donation after brain death (DBD) and donation after cardiac death (DCD) donors. 5 This clinical tool has served as a marker for an increased risk of mortality, morbidity, allograft failure, and cost. 6 EAD has also become a target for therapeutic intervention to reduce morbidity and mortality in LT. [7][8][9] To date, there has been no published study delineating the incidence of and risk factors for EAD specifically in the recipients of liver allografts from DCD donors.Liver allografts from DCD donors are considered inferior because of an overall increased rate of allograft failure. [10][11][12] For this type of donor, the declaration of death is based on cardiopulmonary criteria

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“…Cold ischemia time (CIT) of the donor liver was obtained from the OPTN transplant recipient registration form. The donor risk index (DRI), a measure of donor quality, was calculated according to Feng et al (8) Larger values of the DRI are associated with donor livers of less quality. Organ travel was based on the distance between the donor hospital and the transplant center and was calculated using the longitude and latitude of each institution.…”

Section: Waiting List Transplants and Liver Discardsmentioning

confidence: 99%

The impact of broader regional sharing of livers: 2‐year results of “Share 35”

Edwards¹,

Harper²,

Hirose

et al. 2016

Liver Transpl

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of 2013, the Organ Procurement and Transplantation Network (OPTN) implemented regional sharing for Model for End-Stage Liver Disease (MELD)/Pediatric End-Stage Liver Disease (PELD) candidates with scores reaching 35 and above ("Share 35"). The goal of this distribution change was to increase access to lifesaving transplants for the sickest candidates with chronic liver disease and to reduce the waiting-list mortality for this medically urgent group of patients. To assess the impact of this change, we compared results before and after policy implementation at 2 years. Overall, there were more liver transplants performed under Share 35 and a greater percentage of MELD/PELD 351 candidates underwent transplantation; waiting-list mortality rates in this group were also significantly lower in the post-policy period. Overall adjusted waiting-list mortality was decreased slightly, with no significant changes in mortality by age group or ethnicity. Posttransplant graft and patient survival was unchanged overall and was unchanged for the MELD/PELD 351 recipients. In conclusion, these data demonstrate that the Share 35 policy achieved its goal of increasing access to transplants for these medically urgent patients without reducing access to liver transplants for pediatric and minority candidates. Although the variance in the median MELD at transplant as well as the variance in transport distance increased, there was a decrease in overall liver discard rates and no change in overall cold ischemia times following broader sharing of these organs. The OPTN will continue to monitor this policy, particularly for longer-term posttransplant survival outcomes.

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Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index

Cited by 1,711 publications

References 38 publications

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

The impact of broader regional sharing of livers: 2‐year results of “Share 35”

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