title: Donor liver dysfunction: application of a new scoring system to identify the marginal donor.
abstract: Livers from marginal donors are increasingly used for transplantation due to the shortage of donor organs. The definition of a marginal donor remains unclear; prediction of organ function is a challenge. In the literature the use of steatotic livers has been associated with poor liver function or even primary dysfunction of the allograft. Tekin et al created a scoring system that classifies a donor as marginal or nonmarginal, using a mathematical model based on donor age and steatosis degree. The aims of this study were to apply the Tekin method to identify marginal and nonmarginal donors and evaluate the influence of the cold ischemia time (CIT) on allograft evolution. We retrospectively reviewed deceased donor liver transplantations performed from October 1995 to March 2006, namely, 177 adult liver transplantations in 163 patients. Fifty-five were excluded due to retransplantation (14) or insufficient data (41). Donor age and macrovesicular steatosis were evaluated according to the mathematical formula proposed by Tekin et al, classifying the donors as marginal versus nonmarginal. The authors also analyzed the CIT, 3-month mortality, and development of primary nonfunction or primary dysfunction. The median donor age was 38.9 years (range, 6-71). The postreperfusion biopsy specimen showed moderate to intense steatosis (>30%) in 14.75% of specimens, with no steatosis or mild steatosis in 85.25%. Sixty-one grafts (50%) developed primary graft dysfunction (PGD): 10 grafts, with primary nonfunction (PNF); and 51 with initial poor function (IPF). Using the criteria provided by Tekin et al, we obtained 41 marginal and 81 nonmarginal allografts. The marginal group showed 61.9% PGD, compared with 59.2% of PGD by the nonmarginal group. The CIT was greater than 12 hours in 5 marginal group transplants and 4 PGD cases (80%). Of the nonmarginal allografts, the CIT was greater than 12 hours in 29.6%, with 75% PGD. The 3-month graft survival rate was 80% in the marginal group with ischemia time more than 12 hours: 86.1% of the same group when CIT was less than 12 hours, and 82.7% in the nonmarginal group. In contrast, when we analyzed the occurrence of allograft dysfunction, the 3-month mortality rate was 34% among, grafts with dysfunction, whereas, in those without initial dysfunction, it was 4.1%. In conclusion, the score suggested by Tekin et al that classifies the donors as ideal (nonmarginal) or marginal was not able to predict initial primary dysfunction.
authors.affiliation: Albert Einstein Jewish Hospital, Av. Albert Einstein 627/701, 05652-900 São Paulo/SP, Brazil. ben-hur@einstein.br
authors.forename: B H
authors.initials: BH
authors.lastname: Ferraz-Neto
authors.forename: M P V C
authors.initials: MP
authors.lastname: Zurstrassen
authors.forename: R
authors.initials: R
authors.lastname: Hidalgo
authors.forename: L E P
authors.initials: LE
authors.lastname: Fonseca
authors.forename: T D B
authors.initials: TD
authors.lastname: Motta
authors.forename: F L
authors.initials: FL
authors.lastname: Pandullo
authors.forename: M B
authors.initials: MB
authors.lastname: Rezende
authors.forename: S P
authors.initials: SP
authors.lastname: Meira-Filho
authors.forename: J R
authors.initials: JR
authors.lastname: Sá
authors.forename: R C
authors.initials: RC
authors.lastname: Afonso
mesh_terms: D000328:Adult; D001706:Biopsy; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000473:pathology; D018579:Patient Selection; D012086:Reoperation / Q000706:statistics & numerical data; D015427:Reperfusion Injury / Q000473:pathology; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*