Severity of early allograft dysfunction following donation after circulatory death liver transplantation: a multicentre study

Abstract

Background: Early allograft dysfunction (EAD) is associated with decreased graft and patient survival rates. This study aimed to identify the severity of EAD and develop a predictive model for EAD after donation after circulatory death (DCD) liver transplantation (LT). Furthermore, the influence of operative time on EAD incidence was also evaluated. Methods: In this retrospective, multicentre cohort study, nomograms were established based on a singlecentre training cohort (n=321) and validated in a 3-center validation cohort (n=501). Results: The incidence rate of EAD was 46.4% (149/321) in the training cohort and 40.5% (203/501) in the validation cohort. Of the 149 EAD patients in the training cohort, 77 patients with either elevated alanine aminotransferase (ALT) or aspartate aminotransferase (AST) were classified as having EAD type A, and the rest of the EAD patients were classified as having EAD type B. Recipients with EAD type B had lower graft and patient survival rates than recipients with EAD type A (P=0.043 and 0.044, respectively). We further developed a nomogram to predict EAD (graft weight, cold ischemia time, donor age, model for endstage liver disease (MELD) score) and another nomogram to predict EAD type B (graft weight, cold ischemia time, MELD score). The nomograms for the prediction of EAD and EAD type B had good discrimination [concordance index (C-index) =0.712 (0.666-0.758), 0.707 (0.641-0.773)] and calibration [Hosmer-Lemeshow (HL) P=0.384, P=0.425] in the validation cohort. An increased operative time (>6 h) was associated with increased EAD and EAD type B incidence in the high-risk group (P=0.005, P=0.020, respectively).Conclusions: EAD type B was associated with decreased graft and patient survival rates. The novel nomograms effectively predicted the incidence of EAD and EAD type B in DCD LT patients.

Predictive Value of Preoperative Positive Urine Cytology for Development of Bladder Cancer After Nephroureterectomy in Patients With Upper Urinary Tract Urothelial Carcinoma: A Prognostic Nomogram Based on a Retrospective Multicenter Cohort Study and Systematic Meta-Analysis

“…Prior to this study, the information collection and experimental procedures of this study were approved by the institutional review board. In total, from January 2008 (25)(26)(27). We extracted the following parameters from the hospital medical records: sex, age, chief complaint, tumor traits (site, stage, grade, laterality, location, and focality), lymph node status, surgery type, and adjuvant chemotherapy.…”

Decreasing Significance of Early Allograft Dysfunction with Rising Use of Nonconventional Donors

“…With ongoing efforts to increase the utilization of nonconventional donor organs, there has been an observed increase in the frequency of EAD [4,22,23]. Historically, the occurrence of EAD has strongly correlated with poor post-transplant outcomes in published reports using conventional DBD grafts [11][12][13].…”

“…Historically, the occurrence of EAD has strongly correlated with poor post-transplant outcomes in published reports using conventional DBD grafts [11][12][13]. Despite data suggesting inferiority, the causes of EAD are likely multifactorial and dependent on the unique characteristics of individual liver allografts and recipients [17,[21][22][23]. In recent years, EAD has become a common occurrence at our center along with increased use of grafts from nonconventional donors.…”

“…Along with increasing use of nonconventional, often termed marginal liver allografts, there have also been parallel improvements in surgical technique, perioperative management, and outcomes [4,5,[18][19][20]. Causes of EAD are likely multifactorial and dependent on unique characteristics of individual liver allografts, intraoperative events, and recipient demographics [17,[21][22][23]. In recent years, EAD has become a common occurrence at our center, which has also paralleled our increasing use of grafts from nonconventional donors.…”

Comment on: “Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS Liver PROTECT randomized clinical trial”

“…In previously published studies, it was a post-cold storage NMP with a mean duration of cold ischemic storage ranging from 2 to 8 hours (4-6). The authors highlight the importance of avoiding this duration of cold ischemia to optimize outcomes, particularly for DCD grafts for which the incidence of EAD can reach up to 46% (7). In France, the incidence of EAD for DCD grafts is around 18% and similar to the OCS group, thanks to both the application of selection criteria for DCD grafts and the use of in situ normothermic regional perfusion (8).…”