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Lai Q, Ghinolfi D, Avolio AW, Manzia TM, Mennini G, Melandro F, Frongillo F, Pellicciaro M, Larghi Laureiro Z, Aglietti R, Franco A, Quaranta C, Tisone G, Agnes S, Rossi M, de Simone P. Proposal and validation of a liver graft discard score for liver transplantation from deceased donors: a multicenter Italian study. Updates Surg 2022; 74:491-500. [PMID: 35275380 PMCID: PMC8995238 DOI: 10.1007/s13304-022-01262-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
Several studies have explored the risk of graft dysfunction after liver transplantation (LT) in recent years. Conversely, risk factors for graft discard before or at procurement have poorly been investigated. The study aimed at identifying a score to predict the risk of liver-related graft discard before transplantation. Secondary aims were to test the score for prediction of biopsy-related negative features and post-LT early graft loss. A total of 4207 donors evaluated during the period January 2004–Decemeber 2018 were retrospectively analyzed. The group was split into a training set (n = 3,156; 75.0%) and a validation set (n = 1,051; 25.0%). The Donor Rejected Organ Pre-transplantation (DROP) Score was proposed: − 2.68 + (2.14 if Regional Share) + (0.03*age) + (0.04*weight)-(0.03*height) + (0.29 if diabetes) + (1.65 if anti-HCV-positive) + (0.27 if HBV core) − (0.69 if hypotension) + (0.09*creatinine) + (0.38*log10AST) + (0.34*log10ALT) + (0.06*total bilirubin). At validation, the DROP Score showed the best AUCs for the prediction of liver-related graft discard (0.82; p < 0.001) and macrovesicular steatosis ≥ 30% (0.71; p < 0.001). Patients exceeding the DROP 90th centile had the worse post-LT results (3-month graft loss: 82.8%; log-rank P = 0.024).The DROP score represents a valuable tool to predict the risk of liver function-related graft discard, steatosis, and early post-LT graft survival rates. Studies focused on the validation of this score in other geographical settings are required.
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Affiliation(s)
- Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Davide Ghinolfi
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Alfonso W Avolio
- Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Tommaso M Manzia
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Gianluca Mennini
- Hepatobiliary and Organ Transplantation Unit, Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabio Melandro
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Francesco Frongillo
- Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Marco Pellicciaro
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Zoe Larghi Laureiro
- Hepatobiliary and Organ Transplantation Unit, Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Rebecca Aglietti
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Antonio Franco
- Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Claudia Quaranta
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Salvatore Agnes
- Università Cattolica - Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Massimo Rossi
- Hepatobiliary and Organ Transplantation Unit, Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Paolo de Simone
- Division of Hepatic Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
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