Increased donor risk: Who should bear the burden?

Feng, Sandy

doi:10.1002/lt.21790

Cited by 12 publications

(19 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast with previous data, a recent study suggested that steatotic grafts do not exacerbate the progression of fibrosis nor negatively affect long-term survival in HCV recipients [58]. The literature is divided on the effect of donor graft steatosis as a facilitator or stimulator of fibrosis on patients with post-LT HCV recurrence [33,54,58]. Longer followup studies are necessary to clarify the effect of allograft steatosis in the natural history of HCV recurrence [59].…”

Section: Impact Of Graft Steatosis On Long-term Outcome After Ltmentioning

confidence: 85%

“…However, while there is general agreement that mild steatosis (<30%) causes minor graft injury, studies have been inconsistent regarding the relevance of the higher degree of steatosis (>30%) or type of fat [1,12,24,[33][34][35][36]. For example, the primary non function rates range between 0% and 75% in moderate graft steatosis (30-60%) after LT (Table 1).…”

Section: Impact On Early Post-transplant Outcomementioning

confidence: 98%

“…Most centers advocate the concept that steatotic grafts should be directed only to candidates in relatively good clinical condition but higher need of LT (e.g., cirrhotic patients with hepatocarcinoma having MELD <25), and avoid using them for recipients with fulminant liver failure or re-transplantation [19,43,44]. This strategy is based on the rationale that healthier recipients could better tolerate a poor initial graft function or major post-operative complications [33,45,46]. However, caution must be taken in using low quality organs for less urgent patients with questionable survival benefit of LT since they could eventually wait longer for a better organ [47].…”

Section: Referencementioning

confidence: 98%

See 2 more Smart Citations

Liver transplantation using fatty livers: Always feasible?

McCormack

Dutkowski²,

El‐Badry³

et al. 2011

Journal of Hepatology

259

236

View full text Add to dashboard Cite

Steatotic liver grafts represent the most common type of "extended criteria" organs that have been introduced during the last two decades due to the disparity between liver transplant candidates and the number available organs. A precise definition and reliable and reproducible method for steatosis quantification is currently lacking and the potential influence of the chemical composition of hepatic lipids has not been addressed. In our view, these shortcomings appear to contribute significantly to the inconsistent results of studies reporting on graft steatosis and the outcome of liver transplantation. In this review, various definitions, prevalence and methods of quantification of liver steatosis will be covered. Ischemia/reperfusion injury of the steatotic liver and its consequences on post-transplant outcome will be discussed. Selection criteria for organ allocation and a number of emerging protective strategies are suggested.

show abstract

Section: Impact Of Graft Steatosis On Long-term Outcome After Ltmentioning

confidence: 85%

Section: Impact On Early Post-transplant Outcomementioning

confidence: 98%

Section: Referencementioning

confidence: 98%

See 1 more Smart Citation

Liver transplantation using fatty livers: Always feasible?

McCormack

Dutkowski²,

El‐Badry³

et al. 2011

Journal of Hepatology

259

236

View full text Add to dashboard Cite

show abstract

“…Even for the highly vetted MELD score, refitting the score coefficients with an updated data set produced several changes in the relative importance of the variables 27. Second, most of the predictive ability of the LDRI is derived from the donor's age, which single‐handedly explains a significant amount of the variability in posttransplant outcomes 25, 28…”

Section: Donor Risk Indices In Liver Transplantationmentioning

confidence: 99%

Development of organ-specific donor risk indices

et al. 2012

View full text Add to dashboard Cite

Due to the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival using various combinations of donor and recipient characteristics. We will review the kidney donor risk index (KDRI) and liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The Kidney Donor Risk Index has a potential role in developing new kidney allocation algorithms. The Liver Donor Risk Index allows for greater appreciation of the importance of donor factors, particularly for hepatitis C-positive recipients; as the donor risk index increases, rates of allograft and patient survival among these recipients decrease disproportionately. Use of livers with high donor risk index is associated with increased hospital costs independent of recipient risk factors, and transplanting livers with high donor risk index into patients with Model for End-Stage Liver Disease scores < 15 is associated with lower allograft survival; use of the Liver Donor Risk Index has limited this practice. Significant regional variation in donor quality, as measured by the Liver Donor Risk Index, remains in the United States. We also review other potential indices for liver transplant, including donor-recipient matching and the retransplant donor risk index. While substantial progress has been made in developing donor risk indices to objectively assess donor variables that affect transplant outcomes, continued efforts are warranted to improve these indices to enhance organ allocation policies and optimize allograft survival.

show abstract

“…Donor age over 40 years, donation after cardiac death, or split/ partial graft is strongly associated with graft failure [10]. Furthermore, the quality of donor organs has deteriorated in the last 10-15 years [11]. Several years ago, Feng et al introduced the "donor risk index".…”

Section: Matchmeldmentioning

confidence: 99%