O doador marginal: experiência de um centro de transplante de fígado

Extended criteria brain-dead organ donors: Prevalence and impact on the utilisation of livers for transplantation in Brazil

BACKGROUND

Despite its association with higher postoperative morbidity and mortality, the use of extended criteria donor (ECD) livers for transplantation has increased globally due to the high demand for the procedure.

AIM

To investigate the prevalence of ECD in donation after brain death (DBD) and its impact on organ acceptance for transplantation.

METHODS

Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre. The incidence of the Eurotransplant risk factors to define an ECD (ET-ECD) among DBD donors and the likelihood of organ acceptance over the years were analysed. The relationship between organ refusal for transplantation, the occurrence, and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.

RESULTS

A total of 1619 organ donors were evaluated. Of these, 78.31% (n = 1268) had at least one ET-ECD criterion. There was an increase in the acceptance of ECD DBD organs for transplantation (1 criterion: from 23.40% to 31.60%; 2 criteria: from 13.10% to 27.70%; 3 criteria: From 6.30% to 13.60%). For each addition of one ET-ECD variable, the estimated chance of organ refusal was 64.4% higher (OR 1.644, 95%CI 1.469-1.839, P < 0.001). Except for the donor serum sodium > 165 mmol/L (P = 0.310), all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.

CONCLUSION

A high prevalence of ECD DBD was observed. Despite the increase in their utilisation, the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.

Use of Liver Grafts From Deceased Organ Donors With Infectious Diseases

INTRODUCTION

Liver transplant is the only option in reversing liver insufficiency and its complications. It is very important to realize the quality control of organs and tissues used in transplant, as well as to develop diagnostic, treatment, and prophylaxis techniques to prevent other comorbidities and to increase the survival of transplanted patients.

OBJECTIVES

The study describes the characteristics of liver transplant using organs with infectious diseases realized by Liver Transplantation Unit (LTU) of the University Hospital Oswaldo Cruz (UHOC).

METHODS

The methodology is a descriptive, cross-sectional, and retrospective study, with a quantitative approach of all patients submitted for liver transplantation between 2013 and 2017. The research was realized at LTU ambulatory of the UHOC from the analysis of medical records using a semistructured collect instrument for the information acquisition.

RESULTS

Researchers analyzed 127 medical records, 85% of which had transmissible diseases and 15% of which had infectious diseases. Of the infectious diseases, it was observed that 85% were syphilis (16 cases), followed by 10% with Chagas disease and 5% with cytomegalovirus (CMV). The transplant outcomes showed that 68% of organ receptors with infectious diseases achieved good recovery.

CONCLUSION

Organ transplant for those with infectious diseases is a treatment option to improve the life quality of people at any age who present with a chronic disease, where its use has been an alternative well accepted due to the shortage of livers for transplants.

Employment of MELD score for the prediction of survival after liver transplantation

OBJECTIVE

To assess the overall accuracy of the preoperative MELD score for predicting survival after liver transplantation (LT) and appraise medium-term (24 months) predictors of survival.

METHODS

We conducted a cross-sectional study including patients transplanted by the Department of General Surgery and Liver Transplantation of the Oswaldo Cruz University Hospital, University of Pernambuco, between July 15th, 2003 and July 14th, 2009. We used analysis of area under ROC (receiver operating characteristic) as a summary measure of the performance of the MELD score and assessed predictors of medium-term survival using univariate and multivariate analysis.

RESULTS

The cumulative survival of three, six, 12 and 24 months of the 208 patients studied was 85.1%, 79.3%, 74.5% and 71.1%, respectively. The preoperative MELD score showed a low discriminatory power for predicting survival after TH. By univariate analysis, we identified intraoperative transfusion of red blood cells (p <0.001) and platelets (p = 0.004) and type of venous hepatocaval anastomosis (p = 0.008) as significantly related to medium-term survival of the patients studied. However, by multivariate analysis only red blood cell transfusion was a significant independent predictor of outcome.

CONCLUSION

The MELD score showed low overall accuracy for predicting post-transplant survival of patients studied, among which only intraoperative transfusion of red blood cells was identified as an independent predictor of survival in the medium term after TH.