Donor criteria in hepatic transplantation.
The early outcome of 201 liver grafts transplanted consecutively between September 1988 and November 1991 was investigated retrospectively. Donors were categorized according to their hospitalization periods in an intensive care unit (ICU) prior to harvesting, their causes of death, and the variables generally believed to be critical in liver donation, such as arterial hypotension (n = 69; 34.3%), cardiopulmonary resuscitation (n = 20; 9.9%), elevated serum-aminotransferases (s-AT) (n = 11; 5.5%), or an age over 50 years (n = 16; 8.0%). Ninety-one donors (45.3%) spent less than 24 h in an ICU; 29 donors (14.4%) and 14 donors (7.0%) had hospitalization periods generally considered critical of 4-6 days and more than 6 days, respectively. The most common causes of death were subarachnoidal bleeding (n = 70; 34.8%), isolated head injuries (n = 68; 33.8%), and polytraumata (n = 33; 16.4%). The postischemic hepatocellular damage was evaluated comparing peak post-transplant s-AT, which did not differ significantly between groups; nor did donor and recipient ages or cold ischemia times. Fourteen grafts (7.0%) showed a reversible preservation injury presenting with post-transplant s-AT elevated above 2000 IU/l. Five cases (2.5%) of a primary non-functioning graft (PNF) underwent early retransplantation successfully. Serum-aminotransferases (AST: 4944 +/- 2280 IU/l; ATL: 3186 +/- 1918 IU/l) were significantly (P < 0.01) elevated as compared to primary functioning grafts (AST: 699 +/- 935 IU/l; ALT: 620 +/- 701 IU/l). The donor structure of both groups reflected the distribution of variables in the entire collective. No significant overrepresentations were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Jonas
S
S
Chirurgische Klinik und Poliklinik, Universitätsklinikum Rudolf Virchow der Freien Universität Berlin.
Bechstein
W O
WO
Keck
H
H
Lemmens
H P
HP
Blumhardt
G
G
Neuhaus
P
P
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D016887:Cardiopulmonary Resuscitation; D002648:Child; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D008099:Liver / Q000098:blood supply; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase