Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time

Das, Somak; Swain, Sudeepta Kumar; Addala, Pavan Kumar; Balasubramaniam, R.; Gopakumar, C.; Zirpe, Dinesh; Renganathan, Kirubakaran; Kollu, Harsha; Patel, Darshan; Vibhute, Bipin; Rao, Prashantha; Krishnan, Elankumaran; Gopasetty, Mahesh; Khakhar, Anand; Vaidya, Anil; Anand, Raktima

doi:10.1177/1526924816663516

Cited by 4 publications

(4 citation statements)

References 37 publications

(45 reference statements)

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“…What are the current challenges? These are primarily early functional disorders of the graft such as PDF and PNF in 2–15% of cases ( 10 , 11 ), as well as the long-term consequences of the immunosuppression (IS). The primary aim of LT is the generation of a maximum of life years through an optimized allocation of this scarce resource ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

The Graz Liver Allocation Strategy—Impact of Extended Criteria Grafts on Outcome Considering Immunological Aspects

et al. 2020

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Background: Transplant centers are forced to use livers of extended criteria donors for transplantation due to a dramatic organ shortage. The outcome effect of extended donor criteria (EDCs) remains unclear. Thus, this study was designed to assess the impact of EDCs on outcome including immunological aspects after liver transplantation (LT). Patients and Methods: Between November 2016 and March 2018, 49 patients (85.7% male) with a mean age of 57 ± 11 years underwent LT. The impact of EDCs on outcome after LT was assessed retrospectively using both MedOcs and ENIS (Eurotransplant Network Information System). Results: About 80% of grafts derived from extended criteria donors. Alanine aminotransferase/aspartate aminotransferase (AST/ALT) levels elevated more than three times above normal values in organ donors was the only significant risk factor for primary dysfunction (PDF) and primary non-function (PNF)/Re-LT and early non-anastomotic biliary strictures (NAS). Balance of risk (BAR) score did not differ between EDC and non-EDC recipients. PDF (14.3% of all patients) and PNF (6.1% of all patients) occurred in 23.1% of EDC-graft recipients and in 10.0% of non-EDC-graft recipients (RR 2.31, p = 0.663). The 90-day mortality was 3.6%. There was no difference of early non-anastomotic biliary tract complications and biopsy proven rejections (BPR). There was no correlation of PDF/PNF with BPR and NAS, respectively; however, 66.7% of the patients with BPR also developed early NAS ( p < 0.001). Conclusion: With the Graz liver allocation strategy, excellent survival can be achieved selecting livers with no more than 2 not outcome-relevant EDCs for patients with MELD >20. Further, BPR is associated with biliary complications.

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Section: Discussionmentioning

confidence: 99%

The Graz Liver Allocation Strategy—Impact of Extended Criteria Grafts on Outcome Considering Immunological Aspects

et al. 2020

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“…Besides recipient data, donor characteristics were ascribed postoperative prognostic relevance as well 8,9 and crucial intraoperative complications can obviously occur at any time.…”

Section: Introductionmentioning

confidence: 99%

“…Besides recipient data, donor characteristics were ascribed postoperative prognostic relevance as well 8,9 and crucial intraoperative complications can obviously occur at any time. However, to our experience, precise donor data are occasionally unavailable during the early preoperative stage, whereas intraoperative incidents are difficult to predict in general.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Recipient Parameters Allow Early Estimation of Postoperative Outcome and Intraoperative Transfusion Requirements in Liver Transplantation

et al. 2018

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“…The rate of PNF is low (about 2%) [6], but this is a severe condition after LT. The rate of PPF of transplanted livers is higher (>15% in the literature [7]), but these livers can recover. The development of PNF and PPF is dependent on many influencing factors [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

Control of Ischemia-Reperfusion Injury in Liver Transplantation: Potentials for Increasing the Donor Pool

Kahn

Schemmer

2018

Visc Med

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Background: Organ shortage is a growing problem, with a rising number of organs being harvested from extended criteria donors, and this trend will further continue to increase as organ donors are getting older and have more comorbidities. Since this fact is immutable, efforts have been made to reduce the extent of ischemia-reperfusion injury (IRI) as well as of direct and indirect harvest-related graft injury which affects all organs in a more or less distinct way. Methods: In liver transplantation (LT), the activation of Kupffer cells during organ reperfusion, thus provoking microcirculatory disturbances, hypoxia, and endothelial cell injury, is one of the key mechanisms causing graft dysfunction. Multiple approaches have been taken in order to find efficient preconditioning methods by pharmacological pretreatment, controlled induction of ischemia, controlled denervation of donor organs, and reconditioning with machine perfusion to prevent IRI, whereas marginal organs (i.e. steatotic grafts) are especially vulnerable. Results: The above-mentioned approaches have been pursued in experimental and clinical settings. At this time point, however, there is not yet enough clinical evidence available to recommend any particular drug pretreatment or any other intervention for organ preconditioning prior to transplantation. Conclusion: The multifactorial pathophysiology in the setting of IRI in LT requires a multimodal therapeutic approach with the integration of pharmacological and technical means being applied to the donor, the organ per se, and the recipient. Currently, there is no consensus on standardized pretreatment of donor organs in order to improve the transplant outcome.

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Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time

Abstract: Poor donor maintenance as evidenced by donor acidosis and graft macrosteatosis had significant impact in developing IPF when CIT is kept short. Similar study with larger sample size is required to establish extended criteria cutoff values.

Cited by 4 publications

References 37 publications

The Graz Liver Allocation Strategy—Impact of Extended Criteria Grafts on Outcome Considering Immunological Aspects

The Graz Liver Allocation Strategy—Impact of Extended Criteria Grafts on Outcome Considering Immunological Aspects

Preoperative Recipient Parameters Allow Early Estimation of Postoperative Outcome and Intraoperative Transfusion Requirements in Liver Transplantation

Control of Ischemia-Reperfusion Injury in Liver Transplantation: Potentials for Increasing the Donor Pool

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