Journal Article10.1016/J.TRANSPROCEED.2006.12.002
Extended Donor Criteria Have No Negative Impact on Early Outcome After Liver Transplantation: A Single-Center Multivariate Analysis
Peter Schemmer,Arash Nickkholgh,Ulf Hinz,T. Gerling,A. Mehrabi,Peter Sauer,Jens Encke,Helmut Friess,Juergen Weitz,M.W. Büchler,Jan Schmidt +10 more
- 01 Mar 2007
- Vol. 39, Iss: 2, pp 529-534
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TL;DR: It is suggested that the use of grafts from EDC donors are safe and expand the donor pool, and the only independent prognostic factor for survival, regardless of EDC.
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Abstract: The organ shortage has driven many transplant centers to accept extended donor criteria and to modify graft allocation policies. This study was designed to analyze the impact of applying extended donor criteria (EDC) in orthotopic liver transplantation (OLT). Between December 2001 and December 2004, we performed 165 primary cadaveric whole OLTs. Up to three EDC, that is, ventilation >7 days; aminotransferases (ALT or AST) >3 x normal; bilirubin >3 mg/dL; anti-HBc or HBs Ag positivity; donor age >65 years; liver steatosis >40%; donor body mass index >30; cold ischemia time >14 hours; peak serum Na(+) >165 mmol/L; history of extrahepatic malignancy; or previous drug abuse were present in 55% of all grafts. Both univariate and multivariate analysis revealed that EDC status had no effect on graft or patient survival, the necessity for retransplantation, the length of intensive care/intermediate care unit stay, mechanical ventilation, complications, or posttransplant laboratory findings. Recipient age of >/=55 years was the only independent prognostic factor for survival, regardless of EDC. These findings suggested that the use of grafts from EDC donors are safe and expand the donor pool.
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Citations
Extended Criteria Donors in Liver Transplantation.
Irine Vodkin,Alexander Kuo +1 more
TL;DR: This review focuses on frequently cited characteristics, including donor age, steatosis, donation after cardiac death, and donors with increased risk of disease transmission.
172
Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation
Balázs Nemes,György Gámán,Wojciech G. Polak,Fanni Gelley,Takanobu Hara,Shinichiro Ono,Zhassulan Baimakhanov,László Piros,Susumu Eguchi +8 more
TL;DR: Graft survival was excellent up to a DS of 2, however a DS >2 should be avoided in higher-risk recipients, andHypothermic oxygenated machine perfusion can be applied clinically in DCD liver grafts, and Feasibility and safety were confirmed.
Isolation of human hepatocytes by a two-step collagenase perfusion procedure.
TL;DR: This method presents a modified version of a two-step collagenase perfusion procedure to isolate hepatocytes as described by Seglen (1), which results in a large yield of hepatocytes with a viability of 77±10%.
The natural history of inflammatory bowel disease and primary sclerosing cholangitis after liver transplantation--a single-centre experience.
TL;DR: Acute cellular rejection and cytomegalovirus mismatch were both identified as independent predictors of rPSC and the impact of steroids and the ideal immunosuppressive regimen for the control of both IBD and PSC post-transplant requires further examination in prospective studies.
83
Current concepts in transplant surgery: liver transplantation today
TL;DR: LTx is now considered a safe and standardized procedure with a substantially improved graft and patient survival and acceptable morbidity rates and the new problems are the major problems affecting the long-term outcome of transplanted patients.
References
Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation.
John F. Renz,Cindy Kin,Milan Kinkhabwala,Dominique Jan,Rhaghu Varadarajan,Michael J. Goldstein,Robert S. Brown,Jean C. Emond +7 more
TL;DR: Systematic EDC utilization maximizes donor use, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.
204
Resource Utilization in Liver Transplantation: Effects of Patient Characteristics and Clinical Practice
Jonathan Showstack,Patricia P. Katz,John R. Lake,John R. Lake,Robert S. Brown,Robert S. Brown,R. Adams Dudley,Steven H. Belle,Russell H. Wiesner,Rowen K. Zetterman,James E. Everhart +10 more
TL;DR: Recipients who were older, had alcoholic liver disease, or were severely ill were the most expensive to treat; this suggests that organ allocation criteria may affect transplant costs.
203
Correlation between donor age and the pattern of liver graft recovery after transplantation.
Hasan Yersiz,Abraham Shaked,Kim M. Olthoff,David K. Imagawa,Christopher R. Shackleton,Paul Martin,Ronald W. Busuttil +6 more
TL;DR: An increased rate of delayed nonfunction (DNF) of liver grafts procured from older donors is observed, and recognition of such pattern and early retransplantation should decrease mortality.
144
The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis.
Juan Figueras,Juli Busquets,Luis Grande,Eduardo Jaurrieta,Julio Perez-Ferreiroa,Jose Mir,Carlos Margarit,Pedro García López,Juan Vazquez,Daniel Casanova,Angel Bernardos,Emilio De-Vicente,Pascual Parrilla,José M. Ramón,R. Bou +14 more
TL;DR: It is concluded that cold ischemia should be kept less than 12 hr in order to avoid biliary complications and Donors over 60 years old or with plasma sodium > 155 should be carefully evaluated before OLT.
128
Policies in Europe on "marginal quality" donor livers
TL;DR: Assessment of liver grafts from "marginal" donors and attitudes to use of such organs indicates that usable donor livers are being unnecessarily refused on medical grounds.
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