Marginal grafts increase early mortality in liver transplantation

Bacchella, Telésforo; Galvão, Flávio Henrique Ferreira; Almeida, Jorge; Figueira, Estela Regina Ramos; Moraes, Andreza de; Machado, Marcel Cerqueira César

doi:10.1590/s1516-31802008000300005

Cited by 32 publications

(26 citation statements)

References 18 publications

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“…Bacchella et al in 2008 suggested a scoring system to denote the liver graft quality including serum levels of transaminases in donors. In their study, liver grafts from donors with AST and/or ALT levels of more than 600 IU/L were routinely discarded (8). Moreover, studies on machine perfusion during the ex vivo phase of preservation, has shown that the level of transaminase in perfusate fluid may predict primary non-function and graft failure (22).…”

Section: Discussionmentioning

confidence: 99%

“…Elevated levels of serum transaminases in donors signify injury to hepatocytes, thus many transplant experts discard livers with markedly elevated levels of serum transaminases for transplantation (1, 7, 8). In spite of this, it is not clear whether high levels of serum transaminases in the donor will affect the allograft function, and there is no clear upper limit in serum transaminases that contraindicates use in transplantation (5).…”

Section: Introductionmentioning

confidence: 99%

“…In spite of this, it is not clear whether high levels of serum transaminases in the donor will affect the allograft function, and there is no clear upper limit in serum transaminases that contraindicates use in transplantation (5). There are few limited studies, which studied the effect of elevated levels of serum transaminases in donors on the allograft function in recipients (6, 8-10). …”

Section: Introductionmentioning

confidence: 99%

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Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

Fakhar¹,

Nikeghbalian²,

Kazemi³

et al. 2016

Hepat Mon

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BackgroundThe current organ shortage has prompted the use of marginal organs. We conducted this retrospective study to present our experience with transplanting deceased donor livers with elevated levels of serum transaminases and to explain whether elevated levels of serum transaminases in donors affect allograft function and survival of the recipients.MethodsData of deceased donor livers and patients, who underwent liver transplantation from March 2013 to March 2015 at Shiraz center for organ transplantation, was reviewed. Liver donors with aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) level of more than 500 IU/l and their related recipients were considered as the case group (n = 24) and the others were considered as the control group (n = 834).ResultsIn the case group, the medians of levels of serum AST and ALT of donors were 834 ± 425 IU/L (range: 250 - 2285) and 507 ± 367 IU/L (range: 100 - 1600), respectively. Recipients were followed for a median of 13.6 ± 9 months (range: 7 - 28.4). Post-transplant complications were acute rejection (n = 5), infection (n = 3), portal vein thrombosis (n = 3), bile duct stricture (n = 1), and hepatic artery stenosis (n = 1). The one-year survival rate of the patients was 91.7%. Demographics, post-transplant complications and one-year survival rates were not significantly different between the two study groups.ConclusionsTransplanting deceased donor livers with markedly elevated liver enzymes may be an acceptable choice for expanding the donor pool.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

Fakhar¹,

Nikeghbalian²,

Kazemi³

et al. 2016

Hepat Mon

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“…One study reported an increase in mortality in liver transplant patients, especially in cases in which the recipients were more seriously ill. (19) …”

Section: Discussionmentioning

confidence: 99%

Profile of effective donors from organ and tissue procurement services

Rodrigues¹,

Neto²,

Sardinha³

et al. 2014

Revista Brasileira De Terapia Intensiva

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ObjectiveTo characterize the profile of effective organ and tissue donors and to understand which organs and tissues were donated for transplantation.MethodsThis was a quantitative, descriptive, exploratory, retrospective study that analyzed clinical data from 305 donors between January 2006 to December 2010. The data were then analyzed using descriptive analyses, generating frequency tables, measures of position (mean, minimum and maximum) and measures of dispersion (standard deviation) for data that was social and clinical in nature.ResultsThere was an overall predominance of white (72%) and male (55%) individuals between the ages of 41 and 60 years (44%). The primary cause of brain death was cerebrovascular accident (55%). In the patient history, 31% of the patients were classified as overweight, 27% as hypertensive and only 4.3% as having diabetes mellitus. Vasoactive drugs were used in 92.7% of the donors, and the main drug of choice was noradrenaline (81.6%). Hyperglycemia and hypernatremia were diagnosed in 78% and 71% of the donors, respectively.ConclusionSignificant hemodynamic changes were found, and the results indicate that the use of vasoactive drugs was the main strategy used to control these changes. Furthermore, most donors presented with hyperglycemia and hypernatremia, which were frequently reported in association with brain death. The persistent nature of these findings suggests that the organ donors were inadequately maintained.

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“…While some authors feel that marginal donor use portends no impact on recipient survival and graft function [10], others feel that especially in high-MELD donors, the risk of early post-transplant mortality is increased with marginal graft use [11]. Many feel that recipient status should be considered in the use of marginal donors, but the majority of publications advocate the use f marginal or extended donor criteria grafts when the o donor quality can be adapted for the proper recipients [12,13].…”

Section: Discussionmentioning

confidence: 99%

Successful Abdominal Organ Donation after Brain Death in a Patient with a Biventricular Assist Device: Extending Extended Criteria

Carpenter¹,

Steidley²,

Douglas³

et al. 2013

OJOTS

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Few studies address the potential for donation after brain death (DBD) in the limited population of patients with ongoing mechanical circulatory support (MCS). A case study was conducted reviewing available records of both donor and recipient, and available literature. The donor was a young female with an acute myocardial infarction precipitating emergent off-pump 2-vessel bypass graft complicated by profound cardiogenic shock refractory to inotropes and intra-aortic balloon pump. A heparin drip was started following percutaneous placement of a left ventricular-assist device (TandemHeart ® ) which improved her hemodynamics to stabilize for transfer. She ultimately required surgical placement of biventricular assist device (CentraMag ® ) to normalize hemodynamics. Two days post-operatively, she developed a cerebellar hemorrhage and was declared brain dead. Pre-donation blood chemistry showed adequate end-organ function. Both kidneys were placed locally. The liver was rejected for two regional status 1 patients and by all other local centers. We accepted the liver for a patient with polycystic liver disease with a MELD exception score of 20. The recipient is now 4 years post-transplant with excellent graft function. Extending donor criteria to include MCS patients can result in successful transplantation and should be considered in selected circumstances once satisfactory donor end-organ function is established.

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Marginal grafts increase early mortality in liver transplantation

Cited by 32 publications

References 18 publications

Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

Transplantation of Deceased Donor Livers With Elevated Levels of Serum Transaminases at Shiraz Transplant Center

Profile of effective donors from organ and tissue procurement services

Successful Abdominal Organ Donation after Brain Death in a Patient with a Biventricular Assist Device: Extending Extended Criteria

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