Editorial: Advances in clinical liver transplantation: expanding indications and improving peri- and post-transplant care

The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres

BACKGROUND

As literature largely focuses on long-term outcomes, this study aimed at elucidating the perioperative outcomes of liver transplant patients receiving a graft from two groups of unconventional expanded criteria donors: brain dead aged > 80 years and cardiac dead.

METHODS

Data of 247 cirrhotic patients transplanted at two high volume liver transplant centers were analysed. Confounders were balanced using a stabilized inverse probability therapy weighting and a propensity score for each patient on the original population was generated. The score was created using a multivariate logistic regression model considering a Comprehensive Complication Index ≥ 42 (no versus yes) as the dependent variable and 11 possible clinically relevant confounders as covariate.

RESULTS

Forty-four patients received the graft from a cardiac-dead donor and 203 from a brain-dead donor aged > 80 years. Intraoperatively, cardiac-dead donors liver transplant cases required more fresh frozen plasma units (P < 0.0001) with similar reduced need of fibrinogen to old brain-dead donors cases. The incidence of reperfusion syndrome was similar (P = 0.80). In the Intensive Care Unit, both the groups presented a comparable low need for blood transfusions, renal replacement therapy and inotropes. Cardiac-dead donors liver transplantations required more time to tracheal extubation (P < 0.0001) and scored higher Comprehensive Complication Index (P < 0.0001) however the incidence of a severe complication status (Comprehensive Complication Index  ≥ 42) was similar (P = 0.52). ICU stay (P = 0.97), total hospital stay (P = 0.57), in hospital (P = 1.00) and 6 months (P = 1.00) death were similar.

CONCLUSION

Selected octogenarian and cardiac-dead donors can be used safely for liver transplantation.

Liver Recovery and Transplantation From Deceased Donors in the Metropolitan Area of the Valley of Mexico

BACKGROUND

Evaluation of donation and transplantation activity allows for strategic planning. Liver donation and transplantation activity in the Metropolitan Area of the Valley of Mexico (MAVM) has never been published. The aim of this study was to analyze deceased liver donation and transplantation, liver use, and observed-to-expected (O:E) ratio in the MAVM.

METHODS

Information from 2014 to 2018 was obtained from the National Center of Transplantation and adjusted per million persons. O:E ratio was analyzed and compared between regions.

RESULTS

From all Mexican states, Mexico City (CDMX) had the highest liver donation and transplantation per million persons rates in the country. In contrast, when the MAVM was considered, the region was sixth in liver donation and first in transplantation, although the latter was not statistically different to Nuevo Leon (5.4 vs 4.3; P = .52). Liver use in Mexico State within the MAVM (37.8%) was not different from that of CDMX (15th in the nation, 35.2%, P = .78), while deceased donor liver use in the rest of the state was statistically higher (52.4%, P = .01; third in the nation). O:E ratio was higher in Mexico states outside the MAVM (CDMX 10.1, 2.1 vs 29.4, 26.5; P = .009).

CONCLUSIONS

Analysis of deceased donation and transplantation of Mexican states without considering the metropolitan areas is insufficient. To consider CDMX as a region without acknowledging the MAVM leads to an inappropriately small denominator during efficiency analysis.