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

Winter, Audrey; Landais, Paul; Azoulay, Daniel; Disabato, Mara; Compagnon, Philippe; Jacquelinet, Christian; Daurès, Jean‐Pierre; Féray, Cyrille

doi:10.1016/j.jhepr.2020.100118

Cited by 5 publications

(4 citation statements)

References 18 publications

(38 reference statements)

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“…A surrogate of a perceived low quality liver donor is the rejection rate for top‐listed candidates before the final acceptance of the graft. The number of rejections even modifies allocation policies in some countries: after being discarded by three teams in Germany or five teams in France, the liver is considered for centre allocation (also called rescue allocation), and thus the transplant program that finally accepts the organ can freely choose the recipient on their waiting list 18–20 . In our study cohort, 19.2% of transplanted candidates received a liver donor that fulfilled our definition of perceived poor liver quality.…”

Section: Discussionmentioning

confidence: 95%

“…The number of rejections even modifies allocation policies in some countries: after being discarded by three teams in Germany or five teams in France, the liver is considered for centre allocation (also called rescue allocation), and thus the transplant program that finally accepts the organ can freely choose the recipient on their waiting list. [18][19][20] In our study cohort, 19.2% of transplanted candidates received a liver donor that fulfilled our definition of perceived poor liver quality. These rates are consistent with other European series, where the use of previously discarded donors ranged between 8.2% and 34%.…”

Section: Discussionmentioning

confidence: 99%

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The impact of perceived donor liver quality on post‐transplant outcome

Dirchwolf

Becchetti

Stampf

et al. 2023

ANZ Journal of Surgery

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Background: We analysed the impact of perceived liver donor quality on transplant recipient outcomes. Methods: this prospective cohort study included all deceased liver donors during 2008-2018 in the Swiss Transplant Cohort Study. Perceived low-quality liver donors were defined when refused for ≥5 top listed recipients or for all recipients in at least one centre before being transplanted. The effect of liver donor quality on relisting or recipient death at 1 week and 1 year after transplantation was analysed using Kaplan-Meier and Cox proportional hazard models. A 1:3 matching was also performed using a recipient score. Results: Of 973 liver donors, 187 (19.2%) had perceived poor-quality. Males, obesity, donation after circulatory death and alanine aminotransferase values were significantly associated with perceived poor-quality, with no significant effect of the perceived quality on relisting or death within the first week and first year post-transplant [(aHR) = 1.45, 95% CI: (0.6, 3.5), P = 0.41 and aHR = 1.52 (95% CI 0.98-2.35), P = 0.06], adjusting by recipient age and gender, obesity, diabetes, prior liver transplantation and model for end-stage liver disease (MELD) score. At 1 year, prior liver transplantation and higher MELD score associated with higher risk of re-listing or death. Conclusion: Comparable post-transplant outcomes with different perceived quality liver donors stresses the need to improve donor selection in liver transplantation.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

The impact of perceived donor liver quality on post‐transplant outcome

Dirchwolf

Becchetti

Stampf

et al. 2023

ANZ Journal of Surgery

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show abstract

“…In this issue, Winter et al reported on the French experience of using a center-allocation (CA) system compared to the standard patientallocation (PA) system. 11 Indeed, in France, liver grafts are allocated to patients based on the MELD score with a strategy of the "sickest first". When a liver graft is refused consecutively at least 5 times, this graft is supplied to a transplant center which can choose the recipient on the waiting list (center-allocation).…”

Section: Coagulation In Cirrhosis Is a Complex Issue Where The Classical Tests (International Normalized Ratio [Inr] Activated Partial Thmentioning

confidence: 99%

Quality and reproducibility during the COVID-19 pandemic

Gustot

2020

JHEP Reports

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“…elderly or steatotic donors), and grafts entailing the risk of infection or malignancy for the recipient ( 4 ). In the coming years, there will be a need to use liver grafts from donors with such pathologies to reduce the waiting-list for transplant ( 5 , 6 ). It is also foreseeable that the prevalence of metabolic pathologies (that affect negatively the post-operative outcomes) will increase in patients submitted to hepatic resection ( 7 ).…”

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confidence: 99%