Elsevier

Transplantation Proceedings

Volume 47, Issue 7, September 2015, Pages 2102-2105
Transplantation Proceedings

38th National Congress of the Italian Transplantation Society
Donation
Overextended Criteria Donors: Experience of an Italian Transplantation Center

https://doi.org/10.1016/j.transproceed.2014.11.077Get rights and content

Highlights

  • Use of marginal donor grafts is an alternative to overcome the organ shortage.

  • We report the outcome of patients who underwent transplantation with marginal grafts compared with patients who underwent transplantation with grafts from SD.

  • The overall survival and outcome in extended criteria liver donors are similar to that of ideal donors.

Abstract

The increasing gap between the number of patients who could benefit from liver transplantation and the number of available donors has fueled efforts to maximize the donor pool using marginal grafts that usually were discarded for transplantation. This study included data of all patients who received decreased donor liver grafts between January 2004 and January 2013 (n = 218) with the use of a prospectively collected database. Patients with acute liver failure, retransplantation, pediatric transplantation, and split liver transplantation were excluded. Donors were classified as standard donor (SD), extended criteria donor (ECD), and overextended criteria donor (OECD). The primary endpoints of the study were early allograft primary dysfunction (PDF), primary nonfunction (PNF), and patient survival (PS), whereas incidence of major postoperative complications was the secondary endpoint. In our series we demonstrated that OECD have similar outcome in terms of survival and incidence of complication after liver transplantation as ideal grafts.

Section snippets

Patients and Methods

The study included data of 218 patients who received deceased donor liver grafts between January 2004 and January 2013 in our transplantation center. We excluded patients with acute liver failure, pediatric transplantation, split liver transplantation, and retransplantation. The minimum follow-up was 12 months.

Until 2007, liver transplantations were performed using an end-to-end anastomosis of the retrohepatic donor cava to the resected retrohepatic recipient cava with venovenous bypass.

Results

The 3 groups were well matched regarding age, gender, indication of liver transplantation, and MELD score (Table 2).

There was no significant difference in surgical variables, such as transplantation technique, vascular reconstruction, median operative time, or cold ischemia time (Table 2).

PNF occurred in 13 patients (5.9%) whereas PDF occurred in 12 patients (5.5%), and there were no significant differences in the 3 groups (Table 3).

Postoperative complications were classified as biliary

Discussion

The shortage of ideal liver grafts for OLT has led transplantation teams to investigate other sources of grafts. Marginal donors may be a real option to expand the donor pool [21], [22], [23].

Definitions of marginal donors vary from center to center; because of the lack of organs more centers now transplant livers that were previously considered unacceptable. The combination of multiple marginal factors seems to be additive to graft injury.

Several studies had investigated the effect of donor

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