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Akabane M, Bekki Y, Imaoka Y, Inaba Y, Esquivel CO, Kwong A, Melcher ML, Sasaki K. Has the risk of liver re-transplantation improved over the two decades? Clin Transplant 2023; 37:e15127. [PMID: 37772621 DOI: 10.1111/ctr.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/02/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Despite advancements in liver transplantation (LT) over the past two decades, liver re-transplantation (re-LT) presents challenges. This study aimed to assess improvements in re-LT outcomes and contributing factors. METHODS Data from the United Network for Organ Sharing database (2002-2021) were analyzed, with recipients categorized into four-year intervals. Trends in re-LT characteristics and postoperative outcomes were evaluated. RESULTS Of 128,462 LT patients, 7254 received re-LT. Graft survival (GS) for re-LT improved (91.3%, 82.1%, and 70.8% at 30 days, 1 year, and 3 years post-LT from 2018 to 2021). However, hazard ratios (HRs) for GS remained elevated compared to marginal donors including donors after circulatory death (DCD), although the difference in HRs decreased in long-term GS. Changes in re-LT causes included a reduction in hepatitis C recurrence and an increase in graft failure post-primary LT involving DCD. Trends identified included recent decreased cold ischemic time (CIT) and increased distance from donor hospital in re-LT group. Meanwhile, DCD cohort exhibited less significant increase in distance and more marked decrease in CIT. The shortest CIT was recorded in urgent re-LT group. The highest Model for End-Stage Liver Disease score was observed in urgent re-LT group, while the lowest was recorded in DCD group. Analysis revealed shorter time interval between previous LT and re-listing, leading to worse outcomes, and varying primary graft failure causes influencing overall survival post-re-LT. DISCUSSION While short-term re-LT outcomes improved, challenges persist compared to DCD. Further enhancements are required, with ongoing research focusing on optimizing risk stratification models and allocation systems for better LT outcomes.
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Affiliation(s)
- Miho Akabane
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Yuki Bekki
- Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Yuki Imaoka
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Carlos O Esquivel
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Allison Kwong
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Marc L Melcher
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, California, USA
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2
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Novruzbekov MS, Lutsyk KN, Olisov OD, Magomedov KM, Kazymov BI, Alekberov KF, Akhmedov AR, Yaremin BI. [Indocyanine green in liver transplantation]. Khirurgiia (Mosk) 2023:63-72. [PMID: 37682549 DOI: 10.17116/hirurgia202309263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The purpose of this study was to evaluate the first own experience of using indocyanine green (ICG) in liver transplantation compared to literature data and to determine its potential for clinical practice. Liver transplantation is an effective option for patients with end-stage disease, but this procedure is associated with many problems such as graft rejection, graft dysfunction, surgical risk and postoperative management. Modern methods for assessing graft function have their limitations, so a more efficient method is needed. According to this review, ICG fluorescence is valuable for effective intraoperative blood flow control, assessment of graft function, intraoperative and postoperative monitoring of clinical status. ICG fluorescence can also predict clinical status of patients at all stages of liver transplantation. Routine ICG fluorescence method is advisable in liver transplantation to improve outcomes and optimize treatment process.
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Affiliation(s)
- M S Novruzbekov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K N Lutsyk
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - O D Olisov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K M Magomedov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - B I Kazymov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - K F Alekberov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A R Akhmedov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - B I Yaremin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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3
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Marginal donor liver versus standard donor liver: A single center-observational study. Hepatobiliary Pancreat Dis Int 2022; 22:239-244. [PMID: 36323609 DOI: 10.1016/j.hbpd.2022.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effectiveness and safety of marginal donor livers remain controversial. This study aimed to investigate the clinical efficacy of marginal donor livers in patients with liver transplantation (LT). METHODS This study included 199 liver donors (including 16 split donors) and 206 liver recipients from January 1, 2018 to January 27, 2020, with case follow-up until July 2021. Clinical data of donors and recipients were retrospectively analyzed and were divided into the marginal donor and standard donor groups according to the criteria of marginal donor livers. Indices of liver and kidney functions, complications, and survival curves of the two groups were compared. RESULTS Compared with the standard donor group, the blood creatinine levels were significantly higher in the marginal donor group in the first week after operation (P < 0.05); there were no significant differences in the alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels after LT (all P > 0.05); there was no significant difference in the incidence of complications after LT (P > 0.05); there was also no significant difference in the survival curve (P = 0.335). CONCLUSIONS There were no significant differences in liver and kidney function and survival curve between the standard donor and marginal donor groups. The marginal donor liver appears safe and reliable for LT and may be an important strategy to expand the donor pool and solve the shortage of organs.
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4
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An Assessment of Ineligible Donor Use in Solid Organ Transplant. Transplantation 2022; 106:1629-1637. [DOI: 10.1097/tp.0000000000004084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Abstract
Severe allograft dysfunction, as opposed to the expected immediate function, following liver transplantation is a major complication, and the clinical manifestations of such that lead to either immediate retransplant or death are the catastrophic end of the spectrum. Primary nonfunction (PNF) has declined in incidence over the years, yet the impact on patient and healthcare teams, and the burden on the organ pool in case of the need for retransplant should not be underestimated. There is no universal test to define the diagnosis of PNF, and current criteria are based on various biochemical parameters surrogate of liver function; moreover, a disparity remains within different healthcare systems on selecting candidates eligible for urgent retransplantation. The impact on PNF from traditionally accepted risk factors has changed somewhat, mainly driven by the rising demand for organs, combined with the concerted approach by clinicians on the in-depth understanding of PNF, optimal graft recipient selection, mitigation of the clinical environment in which a marginal graft is reperfused, and postoperative management. Regardless of the mode, available data suggest machine perfusion strategies help reduce the incidence further but do not completely avert the risk of PNF. The mainstay of management relies on identifying severe allograft dysfunction at a very early stage and aggressive management, while excluding other identifiable causes that mimic severe organ dysfunction. This approach may help salvage some grafts by preventing total graft failure and also maintaining a patient in an optimal physiological state if retransplantation is considered the ultimate patient salvage strategy.
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Affiliation(s)
- Hermien Hartog
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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6
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Cherchi V, Mea VD, Terrosu G, Brollo PP, Pravisani R, Calandra S, Scarpa E, Ventin M, D'Alì L, Lorenzin D, Loreto CD, Risaliti A, Baccarani U. Assessment of hepatic steatosis based on needle biopsy images from deceased donor livers. Clin Transplant 2021; 36:e14557. [PMID: 34890087 DOI: 10.1111/ctr.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/25/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessment of hepatic steatosis (HS) before transplantation requires the pathologist to read a graft biopsy. A simple method based on the evaluation of images from tissue samples with a smartphone could expedite and facilitate the liver selection. This study aims to assess the degree of HS by analysing photographic images from liver needle biopsy samples. METHODS Thirty-three biopsy-images were acquired with a smartphone. Image processing was carried out using ImageJ: background subtraction, conversion to HSB colour space, segmentation of the biopsy area and evaluation of statistical features of Hue, Saturation, Brightness, Red, Green, and Blue channels on the biopsy area. After feature extraction, correlations were made with gold standard HS percentage assessed at two levels (frozen-section vs. glass-slide). Sensitivity, specificity, and accuracy were calculated for each feature. RESULTS Correlations were found for H, S, R. The sensitivity, specificity and accuracy of the final classifier based on the K* algorithm were 94%, 92%, 94%. LIMITATIONS Accuracy assessment was performed considering macrovesicular steatosis on specimens with mostly < 30% HS. CONCLUSIONS The steatosis assessment based on needle biopsy images, proved to be an effective and promising method. Deep learning approaches could also be experimented with a larger set of images This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Vincenzo Della Mea
- Department of Mathematics and Computer Science, University of Udine, Udine, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Sergio Calandra
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Edoardo Scarpa
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorenzo D'Alì
- Department of Pathology, University Hospital of Udine, Udine, Italy
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Carla Di Loreto
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Pathology, University Hospital of Udine, Udine, Italy
| | - Andrea Risaliti
- Department of General Surgery, Dubai Hospital (DHA), Dubai, UAE
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
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Zamora-Valdés D, Leal-Leyte P, Arvizu-Tachiquin PC, Cárdenas-Rodríguez RF, Ávila-Armendáriz JA, Luévano-González A. Use of liver grafts from cadaveric donors: Implementation impact of a local evaluation and procurement team in Mexico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:220-228. [PMID: 34172431 DOI: 10.1016/j.rgmxen.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Cadaveric donor liver graft retrieval is complex in Mexico. The aim of the present article was to present the experience in liver graft use during the first year of work of a local evaluation and procurement team. MATERIALS AND METHODS We reviewed the organ donation report forms and allocation offer records covering the time frame of December 15, 2017 to December 15, 2018, and registered the donor characteristics, causes of organ discard, causes of declined offers, transport time, and graft and recipient survival at 30 days. RESULTS There were 17 donations and we completed the evaluation of 14. Two donors were considered ideal (14.2%) and 12 were expanded criteria donors (ECDs) (85.7%). Two grafts with steatosis were not offered (14.2%). Twelve liver grafts were offered 88 times (mean 7.6 offers per graft). The acceptance rate was 6% for public hospitals and 23.6% for private hospitals (p = 0.016). One graft was discarded during the procurement process due to steatosis. The rate of use after evaluation was 78.5% (11/14). All the grafts were procured by the local team and 9 (81.8%) were transported by commercial airline (median 240 min, range 85 min). Graft and recipient survival at 30 days was 100%. CONCLUSIONS The participation of a local evaluation and procurement team notably increased liver graft use with excellent results. Commercial airline transportation of the grafts to all active transplantation centers of the country resulted in cold ischemia times <6 h.
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Affiliation(s)
- D Zamora-Valdés
- Grupo de Estudio de Trasplante Hepático México, Hospital Ángeles Acoxpa, Mexico City, Mexico.
| | - P Leal-Leyte
- Grupo de Estudio de Trasplante Hepático México, Hospital Ángeles Acoxpa, Mexico City, Mexico
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D'Errico A, Riefolo M, Serenari M, De Pace V, Santandrea G, Monica M, de Cillia C, Ravaioli M, Cescon M, Vasuri F. The histological assessment of liver fibrosis in grafts from extended criteria donors predicts the outcome after liver transplantation: A retrospective study. Dig Liver Dis 2020; 52:185-189. [PMID: 31155489 DOI: 10.1016/j.dld.2019.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/07/2019] [Accepted: 05/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of extended criteria donors (ECD) in liver transplantation is increasing due to the organ shortage. Histological evaluation of the liver graft in the context of procurement is an important tool for extending the donor pool without affecting the quality of the transplanted organs. Macrovesicular steatosis is widely accepted as predictor of early allograft dysfunction (EAD), while other features, such as portal fibrosis, are poorly studied. AIM To identify morphological features, other than macrovesicular steatosis, that may affect recipients' outcome. METHODS Between 2014 and 2016, 132 donors with extended criteria underwent pre-transplant liver biopsy during procurement. Histological variables of the graft, donors'/recipients' clinical data, EAD and patient/graft survival were registered. RESULTS The recipients who received a graft with histological-proven portal fibrosis had a significant lower patient and graft survival in comparison to patients without fibrosis (P = 0.044 and P = 0.039, respectively). Donors' dyslipidemia was significantly associated with the occurrence of EAD (P = 0.021). When dyslipidemia was combined with histological liver fibrosis a 54.5% incidence of EAD was observed (P = 0.012). CONCLUSIONS The histological assessment of liver fibrosis in pre-transplant biopsy of ECD grafts, together with donor's clinical data, provides important information on recipients' outcome.
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Affiliation(s)
- Antonia D'Errico
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Mattia Riefolo
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Serenari
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Vanessa De Pace
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Melissa Monica
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Carlo de Cillia
- Regional Transplant Center, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Ravaioli
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Cescon
- General and Transplant Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
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Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, Malhotra R. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020; 24:804-808. [PMID: 33132564 PMCID: PMC7584817 DOI: 10.5005/jp-journals-10071-23578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Transplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation. Type of study Retrospective observational analysis. Objectives To evaluate the change in organ donation rate and reasons for changes in rates. Subjects Brainstem dead declared patients whose family consented for organ donations in the last 23 years (1997–2019) at Ruby Hall Clinic, Pune, India. Materials and methods Retrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed. Results One hundred cases in the age group 15–75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death remained road traffic accidents (RTA) in both the groups (84.21% till 2013 vs 48.15% after 2013), the proportion of donors declared brain dead due to RTA dipped significantly after 2013 (p = 0.004) and the non-RTA causes of brain dead contributed more than RTA causes (51.85% non-RTA vs 48.15% RTA). The major contributor among non-RTA causes was intracranial bleeds (5.26% before 2013 vs 33.33% after 2013, p = 0.014). Compared to the previous 17 years (from 1997) there were more than fourfold rise in the rate of transplantation in the last 6 years (2014–2019) at our institute. Kidneys were retrieved from 90% donors followed by cornea 84%, liver 65%, heart 22%, skin 7%, lungs 6%, and pancreas 5%. Conclusion We have observed that the cadaveric organ donation rate significantly improved after 2013. Reasons might be widening of the donor pool by the selection of more of non-RTA brain death donors over RTA, acceptability of elderly population donor (>60 years) by our transplant teams, early identification of potential organ donor, and better protocol-based management of the cadaver organ donor. How to cite this article Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020;24(9):804–808.
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Affiliation(s)
- Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Abhijeet Deshmukh
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Prajakta Pote
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Amit Tungenwar
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Ria Malhotra
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Markin NW, Ringenberg KJ, Kassel CA, Walcutt CR, Chacon MM. 2018 Clinical Update in Liver Transplantation. J Cardiothorac Vasc Anesth 2019; 33:3239-3248. [DOI: 10.1053/j.jvca.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/13/2022]
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Lan X, Zhang H, Li HY, Chen KF, Liu F, Wei YG, Li B. Feasibility of using marginal liver grafts in living donor liver transplantation. World J Gastroenterol 2018; 24:2441-2456. [PMID: 29930466 PMCID: PMC6010938 DOI: 10.3748/wjg.v24.i23.2441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/04/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation (LT) is one of the most effective treatments for end-stage liver disease caused by related risk factors when liver resection is contraindicated. Additionally, despite the decrease in the prevalence of hepatitis B virus (HBV) over the past two decades, the absolute number of HBsAg-positive people has increased, leading to an increase in HBV-related liver cirrhosis and hepatocellular carcinoma. Consequently, a large demand exists for LT. While the wait time for patients on the donor list is, to some degree, shorter due to the development of living donor liver transplantation (LDLT), there is still a shortage of liver grafts. Furthermore, recipients often suffer from emergent conditions, such as liver dysfunction or even hepatic encephalopathy, which can lead to a limited choice in grafts. To expand the pool of available liver grafts, one option is the use of organs that were previously considered “unusable” by many, which are often labeled “marginal” organs. Many previous studies have reported on the possibilities of using marginal grafts in orthotopic LT; however, there is still a lack of discussion on this topic, especially regarding the feasibility of using marginal grafts in LDLT. Therefore, the present review aimed to summarize the feasibility of using marginal liver grafts for LDLT and discuss the possibility of expanding the application of these grafts.
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Affiliation(s)
- Xiang Lan
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Zhang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong-Yu Li
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ke-Fei Chen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Fei Liu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong-Gang Wei
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bo Li
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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12
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Single-Center Experience Using Marginal Liver Grafts in Korea. Transplant Proc 2018; 50:1147-1152. [PMID: 29731083 DOI: 10.1016/j.transproceed.2018.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called "marginal donors." METHODS We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30%, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). RESULTS A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5%, 75%, and 69.2% and 85.9%, 83.6%, and 77.2%, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P = .023 and P = .048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR], 4.862 [95% confidence interval (CI), 1.233-19.171]; P = .024) and occurrence of postoperative complications (HR, 4.547 [95% CI, 1.279-16.168]; P = .019) were significantly associated with worse patient overall survival. Also, when factors associated with marginal graft were analyzed separately, graft steatosis >30% was independently associated with survival (HR, 5.947 [95% CI, 1.481-23.886]; P = .012). CONCLUSIONS Patients receiving marginal grafts showed lower but acceptable overall survival and graft survival. However, because graft steatosis >30% was independently associated with worse survival, caution must be exercised when using this type of marginal graft by weighing the risk and benefits.
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13
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Essien EOI, Parimi N, Gutwald-Miller J, Nutter T, Scalea TM, Stein DM. Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation. World J Surg 2018; 41:2933-2939. [PMID: 28620674 DOI: 10.1007/s00268-017-4089-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Organ dysfunction is common after neurologic determination of death (NDD) but before organ collection. Reliable markers for graft success following transplant of these organs would be useful. We sought to determine the relationship between the donor after neurologic determination of death (DNDD) pathophysiology and successful organ donation. METHODS Donor information was obtained through the local organ procurement organization. Donor demographics and clinical data points for cardiovascular, renal, respiratory, hepatic, hematological and neuroendocrine systems were reviewed 12 h before and 12 h after neurologic determination of death was declared. The worst values were utilized for analysis and generation of the organ-specific Sequential Organ Failure Assessment (SOFA) scores. SOFA scores were calculated and used to quantify the degree of organ dysfunction. The NDD non-donors for a specific organ were used as a comparison control group. The control group refers to DNDD patients whose specific organs were not transplanted. Lack of use was mostly due to discard by the transplant team as a result of unsuitability of the organ caused by deterioration or possible donor-specific pathology. RESULTS One hundred and five organ donors were analyzed. Mean age was 35.0 (± 13.6), 78.1% male, median GCS 3, interquartile range (IQR) 3-4 and median injury severity score 32 (IQR 25-43). Of the successful donors, organ-specific severe dysfunction (SOFA 3 or 4) occurred in 96, 27.5 and 3.3% of cardiac, lung and liver donors, respectively. There was no significant difference between the levels of organ dysfunction in donors versus non-donors except lung donors, in which the median lowest partial pressure of arterial oxygen-to-fraction of inspired oxygen (P/F) ratio in the non-donor was 194 (IQR 121.8-308.3) compared to the median lowest P/F ratio in the donor which was 287 (IQR 180-383.5), p = 0.02. In the recipients, graft failure 6 months after transplantation was reported in one kidney recipient (0.74%) (peak donor creatinine = 1 mg/dL) and in five pancreas recipients (11.4%). The median peak glucose of the pancreas donors in failed recipients was 178 mg/dL (IQR 157-213), whereas in the functioning recipients, the median glucose of their donors was not different (185 mg/dL, IQR 157-216), p = 0.394. CONCLUSION Current measures of organ failure and dysfunction do not predict the success of organ donation. Successful donor management in the face of severe organ dysfunction and failure can result in lives saved.
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Affiliation(s)
- Eno-Obong I Essien
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA.
| | - Nehu Parimi
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
| | | | - Tyree Nutter
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R52, Baltimore, MD, 21201, USA
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14
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Kork F, Rimek A, Andert A, Becker NJ, Heidenhain C, Neumann UP, Kroy D, Roehl AB, Rossaint R, Hein M. Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study. BMC Anesthesiol 2018. [PMID: 29523082 PMCID: PMC5845208 DOI: 10.1186/s12871-018-0493-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD). Methods In 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. Results 53.3% (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). Conclusions Patients 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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Affiliation(s)
- Felix Kork
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Alexandra Rimek
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anne Andert
- Department of General, Visceral and Transplantation Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Niklas Jurek Becker
- Department of General, Visceral and Transplantation Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Christoph Heidenhain
- Department of General, Visceral and Oncological Surgery, Sana Hospital Gerresheim, Gräulinger Strasse 120, 40625, Düsseldorf, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplantation Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Daniela Kroy
- Department of Medicine III, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anna B Roehl
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Marc Hein
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
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Pamecha V, Borle DP, Kumar S, Bharathy KGS, Sinha PK, Sasturkar SV, Sharma V, Pandey CK, Sarin SK. Deceased donor liver transplant: Experience from a public sector hospital in India. Indian J Gastroenterol 2018; 37:18-24. [PMID: 29185228 DOI: 10.1007/s12664-017-0801-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/05/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Deceased donor liver transplant (DDLT) is an uncommon procedure in India. We present our experience of DDLT from a public sector teaching hospital. METHODS A retrospective analysis of all DDLT was performed from April 2012 till September 2016. Demographics, intraoperative, donor factors, morbidity, and outcome were analyzed. RESULTS During the study period, 305 liver transplants were performed, of which 36 were DDLT (adult 32, pediatric 4; 35 grafts; 1 split). The median age was 42.5 (1-62) years; 78% were men. The median donor age was 28 (1-77) years; 72.2% were men. About 45% of organs were procured from outside of Delhi and 67% of all grafts used were marginal. Three of 38 liver grafts (7.8%) were rejected due to gross steatosis. Commonest indication was cryptogenic cirrhosis (19.4%). The median model for end-stage liver disease sodium and pediatric end-stage liver disease scores were 23.5 (9-40) and 14.5 (9-22), respectively. Median warm and cold ischemia times were 40 (23-56) and 396 (111-750) min, respectively. Major morbidity of grade III and above occurred in 63.8%. In hospital (90 days), mortality was 16.7% and there were two late deaths because of chronic rejection and biliary sepsis. The overall survival was 77.8% at median follow up of 8.6 (1-54) months. CONCLUSIONS DDLT can be performed with increasing frequency and safety in a public sector hospital. The perioperative and long-term outcomes are acceptable despite the fact that most organs were extended criteria grafts.
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Affiliation(s)
- Viniyendra Pamecha
- Department of Liver Transplantation and Hepatopancreaticobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India.
| | - Deeplaxmi Purushottam Borle
- Department of Liver Transplantation and Hepatopancreaticobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Senthil Kumar
- Department of Liver Transplantation and Hepatopancreaticobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Kishore Gurumoorthy Subramanya Bharathy
- Department of Liver Transplantation and Hepatopancreaticobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Piyush Kumar Sinha
- Department of Liver Transplantation and Hepatopancreaticobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Shridhar Vasantrao Sasturkar
- Department of Liver Transplantation and Hepatopancreaticobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Vibuti Sharma
- Department of Transplant Coordination, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Chandra Kant Pandey
- Department of Anesthesia, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
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Nicolau-Raducu R, Cohen AJ, Bokhari A, Bohorquez H, Bruce D, Carmody I, Bugeaud E, Seal J, Sonnier D, Nossaman B, Loss G. Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients. Clin Transplant 2017; 31. [PMID: 28856732 DOI: 10.1111/ctr.13097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Early allograft dysfunction (EAD) is a well-defined clinical syndrome that reflects overall graft function within the first week after transplant. The aim of this study was to further refine the definition for EAD. METHOD In this study, 1124 patients were included for analysis. Logistic regression was performed to identify markers of liver injury associated with 6-month patient and graft failure. RESULTS Recursive partitioning identified cut-points for ALT/AST > 3000/6000 IU/dL observed within first week, with bilirubin ≥ 10 mg/dL and INR ≥ 1.6 on postoperative day 7 for the revised EAD model. The incidence of updated EAD was 15% (164/1124). Multivariable analysis identified eight risk factors associated with EAD: % macrosteatosis, donor location, donor weight, nonheart beating donors, type of organ transplanted, recipient-associated hepatocellular carcinoma, severity of postreperfusion syndrome, and the amount of transfused fresh frozen plasma. In the presence of EAD, the incidence of post-transplant renal replacement therapy and dialysis dependence increases. There was a significant association of the presence of EAD with 6-month mortality (12% vs 3%) and 6-month graft failure (8% vs 1%). CONCLUSION Higher AST/ALT level needed as cutoff in comparison with the old EAD definition.
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Affiliation(s)
| | - Ari J Cohen
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Amjad Bokhari
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Humberto Bohorquez
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - David Bruce
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Ian Carmody
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Emily Bugeaud
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - John Seal
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Dennis Sonnier
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Bobby Nossaman
- Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - George Loss
- Department of Surgery/Transplantation, Ochsner Clinic Foundation, New Orleans, LA, USA
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17
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Nemes B, Gámán G, Polak WG, Gelley F, Hara T, Ono S, Baimakhanov Z, Piros L, Eguchi S. Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation. Expert Rev Gastroenterol Hepatol 2016; 10:841-59. [PMID: 26831547 DOI: 10.1586/17474124.2016.1149062] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Extended-criteria donors (ECDs) have an impact on early allograft dysfunction (EAD), biliary complications, relapse of hepatitis C virus (HCV), and survivals. Early allograft dysfunction was frequently seen in grafts with moderate and severe steatosis. Donors after cardiac death (DCD) have been associated with higher rates of graft failure and biliary complications compared to donors after brain death. Extended warm ischemia, reperfusion injury and endothelial activation trigger a cascade, leading to microvascular thrombosis, resulting in biliary necrosis, cholangitis, and graft failure. The risk of HCV recurrence increased by donor age, and associated with using moderately and severely steatotic grafts. With the administration of protease inhibitors sustained virological response was achieved in majority of the patients. Donor risk index and EC donor scores (DS) are reported to be useful, to assess the outcome. The 1-year survival rates were 87% and 40% respectively, for donors with a DS of 0 and 3. Graft survival was excellent up to a DS of 2, however a DS >2 should be avoided in higher-risk recipients. The 1, 3 and 5-year survival of DCD recipients was comparable to optimal donors. However ECDs had minor survival means of 85%, 78.6%, and 72.3%. The graft survival of split liver transplantation (SLT) was comparable to that of whole liver orthotopic liver transplantation. SLT was not regarded as an ECD factor in the MELD era any more. Full-right-full-left split liver transplantation has a significant advantage to extend the high quality donor pool. Hypothermic oxygenated machine perfusion can be applied clinically in DCD liver grafts. Feasibility and safety were confirmed. Reperfusion injury was also rare in machine perfused DCD livers.
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Affiliation(s)
- Balázs Nemes
- a Department of Organ Transplantation, Faculty of Medicine, Institute of Surgery , University of Debrecen , Debrecen , Hungary
| | - György Gámán
- b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Wojciech G Polak
- c Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC , University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fanni Gelley
- d Dept of Internal medicine and Gastroenterology , Polyclinic of Hospitallers Brothers of St. John of God , Budapest , Hungary
| | - Takanobu Hara
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Shinichiro Ono
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Zhassulan Baimakhanov
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Laszlo Piros
- b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Susumu Eguchi
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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18
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Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation? Case Rep Transplant 2016; 2016:7074636. [PMID: 27274881 PMCID: PMC4870360 DOI: 10.1155/2016/7074636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/10/2016] [Indexed: 01/15/2023] Open
Abstract
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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19
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Stine JG, Pelletier SJ, Schmitt TM, Porte RJ, Northup PG. Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients. HPB (Oxford) 2016; 18:279-86. [PMID: 27017168 PMCID: PMC4814623 DOI: 10.1016/j.hpb.2015.10.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic artery thrombosis is an uncommon but catastrophic complication following liver transplantation. We hypothesize that recipients with portal vein thrombosis are at increased risk. METHODS Data on all liver transplants in the U.S. during the MELD era through September 2014 were obtained from UNOS. Status one, multivisceral, living donor, re-transplants, pediatric recipients and donation after cardiac death were excluded. Logistic regression models were constructed for hepatic artery thrombosis with resultant graft loss within 90 days of transplantation. RESULTS 63,182 recipients underwent transplantation; 662 (1.1%) recipients had early hepatic artery thrombosis; of those, 91 (13.8%) had pre-transplant portal vein thrombosis, versus 7.5% with portal vein thrombosis but no hepatic artery thrombosis (p < 0.0001). Portal vein thrombosis was associated with an increased independent risk of hepatic artery thrombosis (OR 2.17, 95% CI 1.71-2.76, p < 0.001) as was donor risk index (OR 2.02, 95% CI 1.65-2.48, p < 0.001). Heparin use at cross clamp, INR, and male donors were all significantly associated with lower risk. DISCUSSION Pre-transplant portal vein thrombosis is associated with post-transplant hepatic artery thrombosis independent of other factors. Recipients with portal vein thrombosis might benefit from aggressive coagulation management and careful donor selection. More research is needed to determine causal mechanism.
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Affiliation(s)
- Jonathan G Stine
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, United States
| | - Shawn J Pelletier
- Division of Transplant Surgery, Department of Surgery, University of Virginia, United States
| | - Timothy M Schmitt
- Division of Transplant Surgery, Department of Surgery, University of Kansas, United States
| | - Robert J Porte
- Department of Surgery, University of Groningen, University Medical Center Groningen, Netherlands
| | - Patrick G Northup
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, United States.
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20
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Grąt M, Wronka KM, Patkowski W, Stypułkowski J, Grąt K, Krasnodębski M, Masior Ł, Lewandowski Z, Krawczyk M. Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status. Dig Dis Sci 2016; 61:626-35. [PMID: 26499986 PMCID: PMC4729807 DOI: 10.1007/s10620-015-3910-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/28/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED BackgroundProlonged cold ischemic time (CIT) and increased donor age are well-known factors negatively influencing outcomes after liver transplantation (LT). AIMS The 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. METHODS This 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. RESULTS While 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. CONCLUSIONS In 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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Affiliation(s)
- Michał Grąt
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Karolina M. Wronka
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Waldemar Patkowski
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Jan Stypułkowski
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Karolina Grąt
- />Second Department of Clinical Radiology, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Maciej Krasnodębski
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Łukasz Masior
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Zbigniew Lewandowski
- />Department of Epidemiology, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland
| | - Marek Krawczyk
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
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21
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Defortescu G, Nouhaud FX, Cornu JN, Pfister C. RE: Marginal Donors in Renal Transplantation. Transplant Proc 2015; 47:2081-2. [PMID: 26293106 DOI: 10.1016/j.transproceed.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Guillaume Defortescu
- Department of Urology and Renal Transplantation, Rouen University Hospital, France
| | | | - Jean-Nicolas Cornu
- Department of Urology and Renal Transplantation, Rouen University Hospital, France
| | - Christian Pfister
- Department of Urology and Renal Transplantation, Rouen University Hospital, France.
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