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Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival.

Abstract：

INTRODUCTION:The use of extended criteria donors (ECDs) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors. This study compares the graft/patient survival from standard (SD) and ECD for our transplant population between 2001 and 2005. METHODS:Records of all adult liver transplant recipients over 4 years were reviewed (n = 571). ECD criteria included: age >59 years, BMI >34.9, maximum AST/ALT >500, maximum bilirubin >2.0, peak serum sodium >170, HBV/HCV/HTLV reactive, donation after cardiac death, cold ischemia time >12 hours, ICU stay >5 days, 3 or more pressors simultaneously, extensive alcohol abuse, cancer history (nonskin), active meningitis/bacteremia, or significant donor liver trauma. Outcomes included graft and patient survival at 90 days, 1 year, and 2 years. RESULTS:Sixty-eight percent of recipients (n = 388) received ECD livers. Primary factors accounting for ECD-liver status included: elevated liver function tests (20%), hypernatremia (12.6%), and extensive alcohol abuse (11.4%). Graft survival was (SD, ECD): 90-day 91%, 88%; 1-year 84%, 80%; 2-year 78%, 77%; patient survival was: 90-day 93%, 90%; 1-year 87%, 82%; 2-year 83%, 79%. Kaplan-Meier survival analysis failed to demonstrate an overall difference in graft or patient survival at any time point. Only donor age >60 years was associated with decreased graft and patient survival. CONCLUSIONS:Liver grafts from ECD can be used to dramatically reduce wait list time with outcomes comparable to those for SD without resorting to living donor liver transplantation.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Tector AJ,Mangus RS,Chestovich P,Vianna R,Fridell JA,Milgrom ML,Sanders C,Kwo PY

doi

10.1097/01.sla.0000234896.18207.fa

subject

Has Abstract

pub_date

2006-09-01 00:00:00

pages

439-50

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-200609000-00012

journal_volume

244

pub_type

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Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival.