Comparison of outcomes in ideal donor and extended criteria donor in deceased donor liver transplant: A prospective study

Routh, Dronacharya; Sharma, Sanjay; Naidu, C. S.; Rao, Pankaj P.; Sharma, Anuj; Ranjan, Priya

doi:10.1016/j.ijsu.2014.06.003

Cited by 25 publications

(16 citation statements)

References 12 publications

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“…Nevertheless, due to the known shortage of donor organs [ 21 ] and the current strategy to at least partially counter the gap of supply by use of extended criteria donors (ECD) [ 22 ], only a marginal organ was available and the patient in most critical state. In line with data published by others [ 23 ], use of this ECD-organ in a good patient still resulted in an acceptable outcome. If the patient's liver maximum function capacity would have demonstrated a better residual liver function or longitudinal measurements would have indicated stable kinetics for the decrease of the liver function, one might have considered waiting for another and possibly better organ offer.…”

Section: Discussionsupporting

confidence: 88%

Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation?

Vondran

Schumacher

Johanning

et al. 2016

Case Reports in Transplantation

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Background. Despite aggressive intensive medical management acute liver failure (ALF) may require high-urgency liver transplantation (LTx). Available prognostic scores do not apply for all patients; reliable tools to identify individuals in need of LTx are highly required. The liver maximum function capacity test (LiMAx) might represent an appropriate option. Referring to a case of ALF after Amanita phalloides-intoxication the potential of the LiMAx-test in this setting is discussed. Presentation of Case. LiMAx was performed in a 27-year-old patient prior to and after high-urgency LTx. In accordance with clinical appearance of hepatic encephalopathy, coagulopathy, and acute kidney failure, the LiMAx-test constituted a fulminant course of ALF with hardly any detectable metabolic activity. Following LTx with a marginal donor organ (95% hepatosteatosis), uptake of liver function was demonstrated by postoperative increase of the LiMAx-value. The patient was discharged from hospital on postoperative day 26. Discussion. ALF often is associated with a critical state of the patient that requires almost immediate decision-making regarding further therapy. Application of a noninvasive liver function test might help to determine the prognosis of ALF and support decision-making for or against LTx as well as acceptance of a critical donor organ in case of a critically ill patient.

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Section: Discussionsupporting

confidence: 88%

Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation?

Vondran

Schumacher

Johanning

et al. 2016

Case Reports in Transplantation

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“…Accordingly, it seems that the optimal strategy of donor–recipient matching using a step-by-step process is a reasonable alternative to the calculation of a single risk score, which will never be able to adjust for more complex associations between variables. Given the widespread utilization of organs recovered from extended-criteria donors [ 3 , 26 , 27 ], inclusion of at least the major variables defining general quality of the graft into the currently used MELD-based “sickest first” allocation policy has a strong potential to improve the general results of liver transplant programs by avoiding the highest risk matches.…”

Section: Discussionmentioning

confidence: 99%

Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status

et al. 2015

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BackgroundProlonged cold ischemic time (CIT) and increased donor age are well-known factors negatively influencing outcomes after liver transplantation (LT).AimsThe aim of this study was to evaluate whether the magnitude of their negative effects is related to recipient model for end-stage liver disease (MELD) score.MethodsThis retrospective study was based on a cohort of 1402 LTs, divided into those performed in low-MELD (<10), moderate-MELD (10–20), and high-MELD (>20) recipients.ResultsWhile neither donor age (p = 0.775) nor CIT (p = 0.561) was a significant risk factor for worse 5-year graft survival in low-MELD recipients, both were found to yield independent effects (p = 0.003 and p = 0.012, respectively) in moderate-MELD recipients, and only CIT (p = 0.004) in high-MELD recipients. However, increased donor age only triggered the negative effect of CIT in moderate-MELD recipients, which was limited to grafts recovered from donors aged ≥46 years (p = 0.019). Notably, utilization of grafts from donors aged ≥46 years with CIT ≥9 h in moderate-MELD recipients (p = 0.003) and those with CIT ≥9 h irrespective of donor age in high-MELD recipients (p = 0.031) was associated with particularly compromised outcomes.ConclusionsIn conclusion, the negative effects of prolonged CIT seem to be limited to patients with moderate MELD receiving organs procured from older donors and to high-MELD recipients, irrespective of donor age. Varying effects of donor age and CIT according to recipient MELD score should be considered during the allocation process in order to avoid high-risk matches.

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“…By contrast, the numbers of LTs in Germany and in the Eurotransplant region have been decreasing since a peak in 2010 [ 2 , 3 ]. The decreasing organ donations combined with the persisting high morbidity and mortality of patients on the waiting list has led to a discrepancy between organ supply and demand [ 2 , 4 ] and therefore to the more frequent acceptance extended criteria donors (ECD) to the pool of eligible donors [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study

et al. 2018

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BackgroundThe discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD).MethodsIn this single center retrospective analysis of 122 cadaveric LT recipients, we investigated predictors of postreperfusion syndrome (PRS) including transplant liver quality categorized by both histological assessment of steatosis and subjective visual assessment by the transplanting surgeon using multivariable regression analysis. Furthermore, we describe the relevance of PRS during the intraoperative and postoperative course of LT recipients.Results53.3% (n = 65) of the patients suffered from PRS. Risk factors for PRS were visually assessed organ quality of the liver grafts (acceptable: OR 12.2 [95% CI 2.43–61.59], P = 0.002; poor: OR 13.4 [95% CI 1.48–121.1], P = 0.02) as well as intraoperative norepinephrine dosage before reperfusion (OR 2.2 [95% CI 1.26–3.86] per 0.1 μg kg− 1 min− 1, P = 0.01). In contrast, histological assessment of the graft was not associated with PRS. LT recipients suffering from PRS were hemodynamically more instable after reperfusion compared to recipients not suffering from PRS. They had lower mean arterial pressures until the end of surgery (P < 0.001), received more epinephrine and norepinephrine before reperfusion (P = 0.02 and P < 0.001, respectively) as well as higher rates of continuous infusion of norepinephrine (P < 0.001) and vasopressin (P = 0.02) after reperfusion. Postoperative peak AST was significantly higher (P = 0.001) in LT recipients with PRS. LT recipients with intraoperative PRS had more postoperative adverse cardiac events (P = 0.05) and suffered more often from postoperative delirium (P = 0.04).ConclusionsPatients receiving ECD liver grafts are especially prone to PRS. Anesthesiologists should keep these newly described risk factors in mind when preparing for reperfusion in patients receiving high-risk organs.

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Comparison of outcomes in ideal donor and extended criteria donor in deceased donor liver transplant: A prospective study

Cited by 25 publications

References 12 publications

Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation?

Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation?

Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status

Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study

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