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The impact of major extended donor criteria on graft failure and patient mortality after liver transplantation

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A Correction to this article was published on 22 July 2022

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Abstract

Introduction

Numerous extended donor criteria (EDC) have been identified in liver transplantation (LT), but different EDC have different impacts on graft and patient survival. This study aimed to identify major EDC (maEDC) that were best able to predict the outcome after LT and to examine the plausibility of an allocation algorithm based on these criteria.

Methods

All consecutive LTs between 12/2006 and 03/2014 were included (n = 611). We analyzed the following EDC: donor age > 65 years, body mass index > 30, malignancy and drug abuse history, intensive care unit stay/ventilation > 7 days, aminotransferases > 3 times normal, serum bilirubin > 3 mg/dL, serum Na+ > 165 mmol/L, positive hepatitis serology, biopsy-proven macrovesicular steatosis (BPS) > 40%, and cold ischemia time (CIT) > 14 h. We analyzed hazard risk ratios of graft failure for each EDC and evaluated primary non-function (PNF). In addition, we analyzed 30-day, 90-day, 1-year, and 3-year graft survival. We established low- and high-risk graft (maEDC 0 vs. ≥ 1) and recipient (labMELD < 20 vs. ≥ 20) groups and compared the post-LT outcomes between these groups.

Results

BPS > 40%, donor age > 65 years, and CIT > 14 h (all p < 0.05) were independent predictors of graft failure and patient mortality and increased PNF, 30-day, 90-day, 1-year, and 3-year graft failure rates. Three-year graft and patient survival decreased in recipients of ≥ 1 maEDC grafts (all p < 0.05) and LT of high-risk grafts into high-risk recipients yielded worse outcomes compared with other groups.

Conclusion

Donor age > 65 years, BPS > 40%, and CIT > 14 h are major EDC that decrease short and 3-year graft survival, and 3-year patient survival. An allocation algorithm based on maEDC and labMELD is therefore plausible.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Vladimir J. Lozanovski, Elias Khajeh, Hamidreza Fonouni, Markus Mieth, Christoph W. Michalski, Markus W. Büchler & Arianeb Mehrabi

  2. Department of Internal Medicine IV, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Jan Pfeiffenberger & Karl Heinz Weiss

  3. Department of Anesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Rebecca von Haken & Thorsten Brenner

  4. Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany

    Peter Schirmacher

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  1. Vladimir J. Lozanovski
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  2. Elias Khajeh
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  3. Hamidreza Fonouni
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Contributions

VJL and AM were the main investigators, designed the study, and analyzed and interpreted the data. EK, HF, JP, RH, TB, MM, PS, CWM, KHW, and MWB contributed knowledge, and read and corrected the manuscript. EK performed the statistical analyses. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Arianeb Mehrabi.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The proposed study is a retrospective analysis of liver transplantation cases performed at Heidelberg University Hospital. All procedures were performed following the ethical standards of the institutional research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board at the University of Heidelberg approved the study (reference number S-195/2015). No animal experiments were performed for this study.

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Lozanovski, V.J., Khajeh, E., Fonouni, H. et al. The impact of major extended donor criteria on graft failure and patient mortality after liver transplantation. Langenbecks Arch Surg 403, 719–731 (2018). https://doi.org/10.1007/s00423-018-1704-z

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