Defining Benchmarks in Liver Transplantation

Abstract

Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.

Impact of Machine Perfusion on Biliary Complications after Liver Transplantation

“…Yet, with the advent of modern preservation solutions, simple cooling became very attractive and efficient for keeping an organ transplantable for several hours, without severe loss of viability. Accordingly, cold storage remains also nowadays an easy and very successful preservation technique for normal or ideal liver grafts, actually confirmed by a recent benchmark study of cold stored “ideal” primary liver transplants [ 16 ]. However, for non-ideal, or so-called marginal liver grafts, the limits of static preservations and techniques have been widely recognized, and machine perfusion techniques have recently been acknowledged for their potential advantages in optimizing organ functions in these grafts.…”

“…However, for non-ideal, or so-called marginal liver grafts, the limits of static preservations and techniques have been widely recognized, and machine perfusion techniques have recently been acknowledged for their potential advantages in optimizing organ functions in these grafts. It is notable that definitions of such extended criteria donor livers (ECD) are somewhat arbitrary and include, for example, an advanced donor age of 60–80 years, hepatic steatosis of 15–30 %, and prolonged cold storage of more than 10–12 h [ 16 , 17 , 18 , 19 , 20 , 21 ]. Importantly, most European centers routinely face liver offers from donors above 60 years of age, together with a significant amount of steatosis in the era of non-alcoholic steatohepatitis (NASH) [ 22 , 23 ], implicating that the “normal” liver graft today is often already aged between 60 and 70 years, with significant macrosteatosis up to 15%, and cold ischemia up to 10 h. Of note, such data differs from the US data, underlined by a significantly lower donor risk index (DRI) [ 24 ].…”

Risk Factors for High Mortality on the Liver Transplant Waiting List in Times of Organ Shortage: A Single-Center Analysis

“…However, patients who underwent liver transplantation had outcome results comparable to other transplant centers within the Eurotransplant region [11–13].…”

Physical frailty after liver transplantation

“…Complications are inevitable; in a recent multicenter study including nearly 7500 liver transplant recipients, one half of patients experienced a serious posttransplant complication requiring surgical, radiological, or endoscopic intervention within 1 year of transplantation. 19 Donor quality can further impact these factors, either by slowing the reversal of the liver failure or increasing the risk of surgical complications. Mechanistically, ammonia contributes substantially to pretransplant muscle wasting, a major component of physical frailty, increasing vulnerability to posttransplant stressors, 20 but what biological factors, including sarcopenia, contribute to worsening physical frailty posttransplant remains unknown.…”