Liver transplantation: survival and indexes of donor-recipient matching

Abstract

OBJECTIVE:The aim of this study was to determine the prospective capacity and impact of donor risk index, preallocation survival outcomes following liver transplant, donor model for end-stage liver disease, and balance of risk on patients' 30-day survival after liver transplantation. METHODS:We prospectively analyzed patient survival in a multicentric observational cohort of adult liver transplantation through the year of 2019 at the state of Paraná, Brazil. The receiver operating characteristic curve, the area under the curve, and the best cutoff point (i.e., the Youden's index) were estimated to analyze the prognostic value of each index. RESULTS:In total, 252 liver transplants were included with an average model for end-stage liver disease score of 21.17 and a 30-day survival of 79.76%. The donor risk index was the only prognostic variable with no relation to patients' 30-day mortality model for end-stage liver disease and donor model for end-stage liver disease have no prognostic value on receiver operating characteristic curve, but preallocation survival outcomes following liver transplant, survival outcomes following liver transplant, and balance of risk presented good relationship with this observation. The cutoff value was estimated in 11-12 points for balance of risk and 9-12 for preallocation survival outcomes following liver transplant and survival outcomes following liver transplant. The 30-day survival for the group of transplants with scores up to 12 points (n=172) in all the three indexes was 87.79%, and for those transplants with scores higher than 12 it was 36.36%. CONCLUSIONS:The 30-day survival is 79.76%, and balance of risk, survival outcomes following liver transplant, and preallocation survival outcomes following liver transplant are the good prognostic indexes. The cutoff value of 12 points has clinical usefulness to predict the post-liver transplantation results.

Liver Transplantation in Rescue Allocation: Comparison of the Donor Risk Index, Balance of Risk Score and Graft Function After Liver Transplantation

“…"Even the best organ may fail when transplanted in a severely ill environment with marginal perfusion", 14(p.960) SOFT and BAR scores better predict graft-recipient interaction and post-operative mortality. 31 Given that, our findings demonstrated that the RA group was constituted by less severe patients stratified by BAR score (p = 0.0028), reassuring the notion of high risk organs to fewer sick patients. There was no difference in SOFT score (p = 0.0602), possibly because SOFT score includes recipients' characteristics (ascites, portal vein thrombosis, previous surgeries) that may raise the final score in the RA group.…”

“…The literature brings the notion that livers from expanded criteria donors may be directed to candidates with low MELD scores 4,27,30 and in this cohort lower quality organs (RA group -higher DRI) were allocated to patients with lower MELD scores, finding already reported in literature. [3][4][5][6]11 Liver Transplantation in Rescue Allocation: Comparison of the Donor Risk Index, Balance of Risk Score and Graft Function After Liver Transplantation MELD is well known for its inability to predict post-operative mortality, 31 owing to a lack of fine tuning regarding the graftrecipient match. such as clinical conditions or operative factors.…”

“…1,2,5 Increasing patient overall survival is crucial but it is a difficult topic to discuss because it takes into account variables like allocation, the characteristics of the donor-recipient pair, postoperative care, and socioeconomic progress in society. 31,33 The donor-recipient match area is still a study field, 3 possibly a myth, 34 and the future will tell whether it is still important or will be crushed by the advent of cold or normothermic perfusion technology. This type of outcome analysis is critical to ensure the best possible standard of care in this area of LT, improve transplant benefit 4 and assess the actual degree of risk to the recipient using world in development data.…”

Transplante Hepático na Alocação de Resgate: Comparação do Índice de Risco do Doador, Balanço de Risco e Função do Enxerto Após Transplante Hepático

“…A literatura traz a noção de que os fígados dos doadores de critérios expandidos podem ser dirigidos a candidatos com escores MELD baixos 4,27,30 e nesta coorte órgãos de qualidade inferior (grupo RA -DRI mais alta) foram alocados a pacientes com escores MELD mais baixos, achado já relatado na literatura. [3][4][5][6]11 MELD é bem conhecido por sua incapacidade de prever a mortalidade pós-operatória, 31 devido à falta de ajuste fino em relação à correspondência enxerto-recipiente. Tais como condições clínicas ou fatores cirúrgicos.…”

Normothermic Machine Perfusion—Improving the Supply of Transplantable Livers for High-Risk Recipients

“…Further to this, the risk - benefit assessment must be individualized as not all perspective recipients present with the same risks, nor should they all be expected to glean the same benefits. Despite research into overall risk ( 10 , 11 ), the transplantability of each patient is largely subjective. Surgically high-risk recipients are those patients with certain factors that present additional obstacles, requiring the surgical team to adapt their strategy from that of a routine transplant.…”