Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612766
Poster Visit Session IV Tumors, Liver Surgery and Transplantation – Saturday, January 27, 2018, 8:30am – 9:15am, Foyer area West Wing
Georg Thieme Verlag KG Stuttgart · New York

Major Extended Donor Criteria predict graft failure and patient mortality after liver transplantation – call for caution

Authors

  • V Lozanovski

    1   University Clinic Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg

  • E Khajeh

    1   University Clinic Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg

  • H Fonouni

    1   University Clinic Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg

  • J Pfeiffenberger

    2   University Clinic Heidelberg, Internal Medicine IV, Heidelberg

  • R von Haken

    3   University Clinic Heidelberg, Anesthesiology, Heidelberg

  • T Brenner

    3   University Clinic Heidelberg, Anesthesiology, Heidelberg

  • M Mieth

    1   University Clinic Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg

  • C Michalski

    1   University Clinic Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg

  • K Weiss

    2   University Clinic Heidelberg, Internal Medicine IV, Heidelberg

  • A Mehrabi

    1   University Clinic Heidelberg, General, Visceral and Transplantation Surgery, Heidelberg
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Publikationsverlauf

Publikationsdatum:
03. Januar 2018 (online)

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Background:

Not all extended donor criteria (EDC) have an equal impact on graft survival after liver transplantation (LT). The study was designed to identify major extended donor criteria (maEDC) that are best able to predict graft failure after LT in the MELD-score era.

Methods:

We analyzed 465 consecutive LTs in a single-center setting and examined the EDC: donor age > 65 years, BMI > 30, history of extrahepatic malignancy, history of drug abuse, mechanical ventilation or ICU stay > 7 days, aminotransferases > 3x normal, serum bilirubin > 3 mg/dL, serum-Na > 165mmol/L, positive hepatitis serology, biopsy proven large droplet steatosis (BPS) > 40%, and cold ischemia time (CIT) > 14h. Primary- and delayed non-function (PNF and DNF), short- (90-day), mid- (1-year) and long-term (5-year) graft survival were of primary interest.

Results:

Grafts from donors without EDC were transplanted in 112 cases, whereas 353 patients received marginal organs with at least one EDC. Graft and patient survival did not differ between these groups. The multivariate analysis identified BPS (HR 10.5 95% CI 3.6 – 30.3, p < 0.001), donor age (HR 2.0 95% CI 1.1 – 3.4, p = 0.034), and CIT (HR 2.0 95% CI 1.1 – 3.8, p = 0.025) as major EDC predictive of graft failure. Concomitant presence of a maximum of two major EDC was observed and it increased the PNF-, short-, mid-, and long-term graft failure rates in comparison to cases without major EDC (2.4 vs. 11.4%, 3.3 vs. 17.1%, 7.5 vs. 25.7%, and 7.5 vs. 28.6% respectively; all p < 0.05). Lower 5-year graft survival in the cases of major EDC was observed after controlling for labMELD-score with a cut-off value of 20 (log-rank p = 0.001). Regarding death due to liver failure, 5-year patient survival was 93.2%± 1.8% in the non-major-, and 85.1%± 2.5% in the major EDC-group (p = 0.014).

Conclusion:

Older donor, fatty liver and long CIT decrease long-term patient-, and short- and long-term graft survival, and place the graft at risk for long-term failure irrespective of the labMELD-score of the recipient. These three major criteria outweigh the rest of the EDC and should be used with caution.