Donor Liver Blood Tests and Liver Transplant Outcomes: UK Registry Cohort Study

BACKGROUND

Safely increasing organ utilization is a global priority. Donor serum transaminase levels are often used to decline livers, despite minimal evidence to support such decisions. This study aimed to investigate the impact of donor "liver blood tests" on transplant outcomes.

METHODS

This retrospective cohort study used the National Health Service registry on adult liver transplantation (2016-2019); adjusted regressions models were used to assess the effect of donor "liver blood tests" on outcomes.

RESULTS

A total of 3299 adult liver transplant recipients were included (2530 following brain stem death, 769 following circulatory death). Peak alanine transaminase (ALT) ranged from 6 to 5927 U/L (median = 45). Donor cause of death significantly predicted donor ALT; 4.2-fold increase in peak ALT with hypoxic brain injury versus intracranial hemorrhage (adjusted P  < 0.001). On multivariable analysis, adjusting for a wide range of factors, transaminase level (ALT or aspartate aminotransferase) failed to predict graft survival, primary nonfunction, 90-d graft loss, or mortality. This held true in all examined subgroups, that is, steatotic grafts, donation following circulatory death, hypoxic brain injury donors, and donors, in which ALT was still rising at the time of retrieval. Even grafts from donors with extremely deranged ALT (>1000 U/L) displayed excellent posttransplant outcomes. In contrast, donor peak alkaline phosphatase was a significant predictor of graft loss (adjusted hazard ratio = 1.808; 1.016-3.216; P  = 0.044).

CONCLUSIONS

Donor transaminases do not predict posttransplant outcomes. When other factors are favorable, livers from donors with raised transaminases can be accepted and transplanted with confidence. Such knowledge should improve organ utilization decision-making and prevent future unnecessary organ discard. This provides a safe, simple, and immediate option to expand the donor pool.

Measurement and initial characterization of leukocyte telomere length in 474,074 participants in UK Biobank

Leukocyte telomere length (LTL) is a proposed marker of biological age. Here we report the measurement and initial characterization of LTL in 474,074 participants in UK Biobank. We confirm that older age and male sex associate with shorter LTL, with women on average ~7 years younger in 'biological age' than men. Compared to white Europeans, LTL is markedly longer in African and Chinese ancestries. Older paternal age at birth is associated with longer individual LTL. Higher white cell count is associated with shorter LTL, but proportions of white cell subtypes show weaker associations. Age, ethnicity, sex and white cell count explain ~5.5% of LTL variance. Using paired samples from 1,351 participants taken ~5 years apart, we estimate the within-individual variability in LTL and provide a correction factor for this. This resource provides opportunities to investigate determinants and biomedical consequences of variation in LTL.

Qualitative analysis: a guide to best practice--forensic science extension

Qualitative analysis is arguably the cornerstone of analysis since what cannot be recognised cannot be quantified. This is especially true in the case of the forensic sciences where, for example, the mere presence of a prohibited, or controlled, substance in an unauthorized setting is indicative of a potential offence. This paper presents a set of principles of good practice in qualitative analysis. The principles are placed in the context of forensic science and extend earlier published guidance.

The effects of 10 weeks military training on heel ultrasound and bone turnover

To measure the physiological changes in bone in response to strenuous exercise we performed a prospective study of male army recruits over 10 weeks of basic training. Measurements performed at the start and completion of training consisted of ultrasound (US) measurements of the heel: velocity of sound (VOS in m/seconds) and broadband ultrasound attenuation (BUA in dB/MHz) and bone turnover markers; osteocalcin (OC), bone-specific alkaline phosphatase (BALP), and tartrate-resistant acid phosphatase (TRAP). Forty subjects were recruited for the study and 26 completed training. Over the 10-week study period there was a significant 1.7% fall in mean VOS [mean paired difference (mpd) 27.2 m/second, SEM 9.5 (95% CI 7.5-46.8) P = 0.009] and a nonsignificant 3.4% increase in BUA (P = 0.159). There were significant falls in markers of bone formation OC [11.6%, mpd 0. 11 microg/liter (95% CI 0.07-0.14) P < 0.001] and BALP [13.3%, mpd 3. 49 U/liter (CI 0.80-6.18) P = 0.013] and a nonsignificant 9.5% fall in TRAP a marker of bone resorption. The 10 recruits subsequently injured had a significantly lower VOS on entry [mean difference 24.2 m/seconds (95% CI 4.6-43.7) P = 0.017] and nonsignificantly raised BUA and baseline levels of all bone markers. The ultrasound changes may be accounted for by increase in trabecular separation and a fall in trabecular connectivity due to microfracture. The decrease in bone markers implies a fall in bone turnover.

Ligand Exchange and Redox Reactions of Chromium(V): Isolation of the Chromium(V) Oxalato Complexes From the Ligand Exchange Reaction of Bis[2-ethyl-2-hydroxybutanoato(2-)]oxochromate(V) With Oxalate in 50% Aqueous Acetic Acid

The moderately stable chromium(v) complex, trans-bis[2-ethyl-2-hydroxybutanoato(2-)] oxo -chromate(v), [Cr( ehba )2O]- (1), has been assessed for its suitability as a synthetic intermediate for the preparation of other chromium(v) complexes. This complex undergoes a ligand exchange reaction with excess oxalic acid to form an equilibrium mixture of chromium(v) complexes which have been assigned the structures [Cr( ehba )2O]-, [Cr( ehba )(ox)O]- (2), [Cr(ox)2O]- (3) and cis -[Cr(ox)2(OH2)O]- (4). The products of the ligand exchange reaction were characterized by a combination of u.v ./visible spectroscopy, e.p.r . spectroscopy and electrochemistry. The equilibrium mixture of chromium(v) complexes decays to form chromium(III) products by a redox reaction which is much slower than the initial ligand exchange reaction. The difference in the rates of ligand exchange and subsequent reduction allows the extraction of the chromium(v) ligand exchange products into dichloromethane. n.m.r. spectroscopy and electrochemical techniques were used to identify these products. Under appropriate conditions (high oxalic acid concentrations) the major species extracted are the bis [ oxalato (2-)] oxochromate (v) complexes which have been isolated as oily solids in relatively pure form (≥90% pure) for the first time. n.m.r. spectroscopic evidence indicates that the isolated solid was a mixture of (3) and (4) which explains the difficulty encountered in crystallizing the solid. These ligand exchange reactions may be of general utility in the synthesis of chromium(v) complexes.

Measurement of gastrointestinal pH profiles in normal ambulant human subjects

Gastrointestinal (GI) pH has been measured in 66 normal subjects using a pH sensitive radiotelemetry capsule passing freely through the gastrointestinal tract. Signals were recorded with a portable solid state receiver and recording system, enabling unconstrained measurements with normal ambulatory activities for up to 48 h during normal GI transit. Capsule position in the gut was monitored by surface location using a directional detector. Gastric pH was highly acidic (range 1.0-2.5) in all subjects. The mean pH in the proximal small intestine was 6.6 (0.5) for the first hour of intestinal recording. By comparison the mean pH in the terminal ileum was 7.5 (0.4) (p less than 0.001). In all subjects there was a sharp fall in pH to a mean of 6.4 (0.4) (p less than 0.001) as the capsule passed into the caecum. Values are means (SD). pH then rose progressively from the right to the left colon with a final mean value of 7.0 (0.7) (p less than 0.001).

Stereochemistry and absolute signs of 3JP,H nuclear spin coupling constants in methylplatinum(IV) tertiary phosphine complexes

1H-{31P} and 1H-{195Pt} INDOR spectra have been recorded for PtMe3(acac)PPh3. The stereochemical dependence of the absolute signs of 3JP.H for the platinum methyl protons has been determined. An earlier suggestion of the value of such signs in structural studies of alkylplatinum(II)tertiary phosphine complexes has been extended to such complexes of platinum(IV).