The difficulty in defining extended donor criteria for liver grafts: the Eurotransplant experience

Abstract

SummaryDonor criteria for liver grafts have been expanded because of organ shortage. Currently, no exact definitions for extended donor grafts have been established. The aim of this study was to analyze the impact of donor-specific risk factors, independent of recipient characteristics. In collaboration with Eurotransplant and European Liver Transplant Register, solely donor-specific parameters were correlated with 1-year survival following liver transplantation. Analyses of 4701 donors between 2000 and 2005 resulted in the development of a nomogram to estimate graft survival for available grafts. Predictions by nomogram were compared to those by Donor Risk Index (DRI). In the multivariate analysis, cold ischemic time (CIT), highest sodium, cause of donor death, c-glutamyl transferase (c-GT), and donor sex (female) were statistically significant factors for 3 months; CIT, c-GT, and cause of donor death for 12-month survival. The median DRI of this study population was 1.45 (Q1: 1.17; Q3: 1.67). The agreement between the nomogram and DRI was weak (kappa = 0.23). Several donor-specific risk factors were identified for early survival after liver transplantation. The provided nomogram will support quick organ quality assessment. Nevertheless, this study showed the difficulties of determining an exact definition of extended criteria donors.

Eurotransplant donor‐risk‐index and recipient factors: influence on long‐term outcome after liver transplantation – A large single‐center experience

“…Although they were able to demonstrate the interdependency of previously reported donor risk factors (e.g., GGT, cause of death, and cold ischemia time), the agreement between the nomogram and the DRI was weak (28). These authors further pointed to the difficulties of developing a precise prediction tool for outcome after LT based on organ quality alone.…”

Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

“…Advanced donor age, hypernatremia, abnormal liver tests, donor liver steatosis (>30%), prolonged cold ischemia time (CIT) and warm ischemia time, inotropic drug requirement, long intensive care unit (ICU) stay, extended duration of liver hypoperfusion because of cardiac dysrhythmia or cardiac arrest, split grafts, donation after circulatory death, history of malignancies, and a positive viral serology are the most important independent risk factors for graft loss after LT. However, the impact of these factors varies among the different published studies …”

Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients

“…Such factors include donor age, race, gender, donor cause of death, ABO status, cold ischemia time (CIT), vasopressors, previous cardiac arrest, hypo‐ or hypernatremia, steatotic grafts, or nonheart beating donors (DCD) . While their impact on graft function and recipient survival differs significantly in the reported studies, this donor pool may theoretically increase the risk of primary graft nonfunction (PGNF) and initial poor liver function known as early allograft dysfunction (EAD). EAD is a well‐defined clinical syndrome that reflects overall graft function (injury, cholestasis, coagulopathy) within the first week after transplantation.…”