Effects of Graft Quality on Non‐Urgent Liver Retransplantation Survival: Should We Avoid High‐Risk Donors?

Marti, Josep; Fuster, Josep; Navasa, Miquel; Ferrer, Joana; Rimola, Antoni; Pelegrina, Amalia; Fondevila, Constantino; García‐Valdecasas, Juan Carlos

doi:10.1007/s00268-012-1757-z

Cited by 13 publications

(7 citation statements)

References 21 publications

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“…Increasing ECD organ use has significantly decreased wait‐list mortality, encouraging aggressive utilization of higher‐risk organs to bridge the gap in organ shortage . The ability of transplant centers to handle a high‐risk donor has improved with equivalent survival associated with transplantation of a high‐risk donor as compared with low‐risk donors in the current era …”

Section: Limitations and Barriers To Acceptancementioning

confidence: 99%

The donor risk index: A decade of experience

Flores

Asrani

2017

Liver Transpl

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In 2006, derivation of the donor risk index (DRI) highlighted the importance of donor factors for successful liver transplantation. Over the last decade, the DRI has served as a useful metric of donor quality and has enhanced our understanding of donor factors and their impact upon recipients with hepatitis C virus, those with low Model for End-Stage Liver Disease (MELD) score, and individuals undergoing retransplantation. DRI has provided the transplant community with a common language for describing donor organ characteristics and has served as the foundation for several tools for organ risk assessment. It is a useful tool in assessing the interactions of donor factors with recipient factors and their impact on posttransplant outcomes. However, limitations of statistical modeling, choice of donor factors, exclusion of unaccounted donor and geographic factors, and the changing face of the liver transplant recipient have tempered its widespread use. In addition, the DRI was derived from data before the MELD era but is currently being applied to expand the donor pool while concurrently meeting the demands of a dynamic allocation system. A decade after its introduction, DRI remains relevant but may benefit from being updated to provide guidance in the use of extended criteria donors by accounting for the impact of geography and unmeasured donor characteristics. DRI could be better adapted for recipients with nonalcoholic fatty liver disease by examining and including recipient factors unique to this population. Liver Transplantation 23 1216-1225 2017 AASLD.

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Section: Limitations and Barriers To Acceptancementioning

confidence: 99%

The donor risk index: A decade of experience

Flores

Asrani

2017

Liver Transpl

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“…However, there is also no reason to believe that hand transplantation would be substantially different from solid organ transplantation when it comes to chronic rejection and long-term graft survival 5. It may also be true, as it is with organ allografts, that graft survival in retransplantation may be shorter with each subsequent procedure 22. Furthermore, patients who may need (and desire) a second transplantation may plausibly undergo significant psychological distress while awaiting a new limb, especially if they presumably adjusted well to their initial graft.…”

Section: Risks Of Hand Transplantationmentioning

confidence: 99%

“…Thus, a child who was transplanted at age of 10 years might be expected to undergo this operation again with all of the subsequent risks and time dedicated to physical therapy in her mid-20s. Further, if these transplants are similar to solid organs, graft survival would be expected to diminish successively 22. Provided limb viability is an issue, this procedure would therefore be prescribing a number of operations and potential medical complications to the child throughout her life.…”

Section: Hand Transplantation In Childrenmentioning

confidence: 99%

Transplants for non-lethal conditions: a case against hand transplantation in minors

Hedges

Rosoff

2018

J Med Ethics

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Human allografts for life-threatening organ failure have been demonstrated to be lifesaving and are now considered to be standard of care for many conditions. Transplantation of non-vital anatomic body parts has also been accomplished. Hand transplantation after limb loss in adults has been shown to offer some promising benefits in both functional and psychological measures in preliminary studies. It has been suggested to expand eligibility criteria to include minors, with one such operation having already been performed. With this in mind, we examine the current state of hand transplantation research in the context of available alternatives. We examine the ethics of carrying out these operations in minors, including under the protections of clinical research. We argue that children should not be considered for this surgery due to the substantial risks of immunosuppressive medication, the likelihood that the graft will need to be replaced during the patient's lifetime and the lack of significant compensatory advantages over modern prosthetics.

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“…Articles presenting data about survival after ECD are summarized in the only independent donor factor for graft survival, with lower survival when using grafts from donors over 60-years-old [73]. In summary controlled DCD became a fast growing source for OLT.…”

Section: ) Patient Survival Mortalitymentioning

confidence: 99%

“…A homogenous guideline for the management is not possible to set. However in the review of Monbaliu D et al this is suggested to optimize the outcome by donor pretreatment, avoid extended WIT, rapid flush out with low viscosity solution, allocation the liver to the procuring center (diminish CIT), add cytoprotective agents to the perfusion solution, use ex vivo, machine perfusion, and/ or in vivo ECMO perfusion, carefully select the recipient [73]. In large cohorts, a higher DCD graft failure within the first 180 days (20.5% DCD vs. 11.5% DBD; P < 0.001) is demonstrated, with convergence thereafter.…”

Section: Vi) Expert Commentarymentioning

confidence: 99%

Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation

Nemes

Gámán

Polak

et al. 2016

Expert Review of Gastroenterology & Hepatology

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Extended criteria donors (ECDs) have an impact on early allograft dysfunction (EAD), biliary complications, relapse of hepatitis C virus (HCV), and survivals. Early allograft dysfunction was frequently seen in grafts with moderate and severe steatosis. Donors after cardiac death (DCD) have been associated with higher rates of graft failure and biliary complications compared to donors after brain death. Extended warm ischemia, reperfusion injury and endothelial activation trigger a cascade, leading to microvascular thrombosis, resulting in biliary necrosis, cholangitis, and graft failure. The risk of HCV recurrence increased by donor age, and associated with using moderately and severely steatotic grafts. With the administration of protease inhibitors sustained virological response was achieved in majority of the patients. Donor risk index and EC donor scores (DS) are reported to be useful, to assess the outcome. The 1-year survival rates were 87% and 40% respectively, for donors with a DS of 0 and 3. Graft survival was excellent up to a DS of 2, however a DS >2 should be avoided in higher-risk recipients. The 1, 3 and 5-year survival of DCD recipients was comparable to optimal donors. However ECDs had minor survival means of 85%, 78.6%, and 72.3%. The graft survival of split liver transplantation (SLT) was comparable to that of whole liver orthotopic liver transplantation. SLT was not regarded as an ECD factor in the MELD era any more. Full-right-full-left split liver transplantation has a significant advantage to extend the high quality donor pool. Hypothermic oxygenated machine perfusion can be applied clinically in DCD liver grafts. Feasibility and safety were confirmed. Reperfusion injury was also rare in machine perfused DCD livers. I) IntroductionAs discussed earlier, extended criteria donors are used widely. In this chapter a review is given about the impact of ECD on the outcome. Living related liver transplantation is discussed shortly, whether the partial grafts can still be regarded as ECD or not. Machine perfusion, as a possible management was also reviewed briefly. Outcome parameters are divided as possible complications, and survival results. Complications are listed as early graft dysfunction, biliary complications, HCV recurrence. Survival rates are summarized separately. Split, and living related LT discussed briefly, and finally the machine perfusion, as a possible future aspect is summarized. Silberhummer et al figured out the recipients' condition by the delta-MELD: as the difference between the MELD at transplantation and the MELD at listing. Patients with a both delta-MELD>1 and an ECD>2 together had a higher chance to develop EAD, and also significantly higher risk for mortality [3]. Others report a similar incidence of EAD, PNF, acute rejection, biliary complication and also that ECD had no significant effect on either ICU stay or duration of postOLT ventilation, and also the postOLT laboratory test, bleeding, biliary and vascular complication rates were similar in ECD and non-...

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Effects of Graft Quality on Non‐Urgent Liver Retransplantation Survival: Should We Avoid High‐Risk Donors?

Cited by 13 publications

References 21 publications

The donor risk index: A decade of experience

The donor risk index: A decade of experience

Transplants for non-lethal conditions: a case against hand transplantation in minors

Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation

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