Marginal grafts increase early mortality in liver transplantation
Keywords:
Donor selection, Liver transplantation, Directed tissue donation, Tissue and organ procurement, Liver cirrhosisAbstract
CONTEXT AND OBJECTIVE: Expanded donor criteria (marginal) grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. DESIGN AND SETTING: One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. METHODS: We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD), as low MELD (< 20) or high MELD (≥ 20). The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The signifi cance level was 0.05. RESULTS: There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, lowMELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the fi rst month, patient survival was comparable in all groups up to one year. CONCLUSION: The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.
Downloads
References
Mirza DF, Gunson BK, Da Silva RF, Mayer AD, Buckels JA, McMaster P. Policies in Europe on “marginal quality” donor livers. Lancet. 1994;344(8935):1480-3.
Melendez HV, Heaton ND. Understanding “marginal” liver grafts. Transplantation. 1999;68(4):469-71.
Busuttil RW, Farmer DG, Yersiz H, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg. 2005;241(6):905-16; discussion 916-8.
Pokorny H, Langer F, Herkner H, et al. Influence of cumulative number of marginal donor criteria on primary organ dysfunction in liver recipients. Clin Transplant. 2005;19(4):532-6.
Busuttil RW, Tanaka K. The utility of marginal donors in liver transplantation. Liver Transpl. 2003;9(7):651-63.
Figueira ERR, Martino RB, Galvao FH, Machado MAC, Bacchella T, Machado MCC. A modified score for evaluation of liver graft. In: 11th Annual International Congress Scientific Program. Liver Transplantation. 2005;11(7):C-60. [abstract 239]. Available from: http://www3.interscience.wiley.com/cgi-bin/fulltext/110546716/PDFSTART. Accessed in 2008 (Apr 7).
Briceño J, Solórzano G, Pera C. A proposal for scoring marginal liver grafts. Transpl Int. 2000;13(Suppl 1):S249-52.
Busquets J, Xiol X, Figueras J, et al. The impact of donor age on liver transplantation: influence of donor age on early liver function and on subsequent patient and graft survival. Trans- plantation. 2001;71(12):1765-71.
Gastaca M, Valdivieso A, Pijoan J, et al. Donors older than 70 years in liver transplantation. Transplant Proc. 2005;37(9):3851-4.
Agnes S, Avolio AW, Magalini SC, Grieco G, Castagneto M. Marginal donors for patients on regular waiting lists for liver transplantation. Transpl Int. 1996;9(Suppl 1):S469-71.
De Carlis L, Sansalone CV, Rondinara GF, et al. Is the use of marginal donors justified in liver transplantation? Analysis of results and proposal of modern criteria. Transpl Int. 1996; 9(Suppl 1):S414-7.
Karatzas T, Olson L, Ciancio G, et al. Expanded liver donor age over 60 years for hepatic transplantation. Transplant Proc. 1997;29(7):2830-1.
Cameron AM, Ghobrial RM, Yersiz H, et al. Optimal utilization of donor grafts with extended criteria: a single-center experience in over 1000 liver transplants. Ann Surg. 2006;243(6):748-53; discussion 753-5.
Brasil. Ministério da Saúde. Sistema Nacional de Transplantes. Dados estatísticos. Produção de transplantes. Available from: http://portal.saude.gov.br/portal/saude/area.cfm?id_area=1004. Accessed in 2008 (Apr 7).
Amaral AS, Roza BA, Galvão FH, Jardim KM, Medina-Pestana JO. Knowledge of organ donation among one group of Brazilian professors of medicine. Transplant Proc. 2002;34(2):449-50.
Duarte PS, Pericoco S, Miyazaki MC, Ramalho HJ, Abbud-Filho M. Brazilian’s attitudes toward organ donation and transplanta- tion. Transplant Proc. 2002;34(2):458-9.
Williams MA, Lipsett PA, Rushton CH, et al. The physician’s role in discussing organ donation with families. Crit Care Med. 2003;31(5):1568-73.
Salim A, Martin M, Brown C, Rhee P, Demetriades D, Belzberg
H. The effect of a protocol of aggressive donor management: Implications for the national organ donor shortage. J Trauma. 2006;61(2):429-33; discussion 433-5.
Galvão FH, Bakonyi-Neto A, Machado MA, et al. Interferon alpha-2B and liver resection to treat multifocal hepatic epithe- lioid hemangioendothelioma: a relevant approach to avoid liver transplantation. Transplant Proc. 2005;37(10):4354-8.
Galvão FH, de Andrade Júnior DR, de Andrade DR, et al. Hepatocyte transplantation: State of the art. Hepatol Res. 2006;36(4):237-47.
