Marginal grafts increase early mortality in liver transplantation.
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.


METHODS
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 (>or= 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 significance 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, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year.


CONCLUSIONS
The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.
Bacchella
Telesforo
T
Liver Transplantation Service of Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. bacchell@usp.br
Galvão
Flávio Henrique Ferreira
FH
Jesus de Almeida
José Luiz
JL
Figueira
Estela Regina
ER
de Moraes
Andreza
A
César Machado
Marcel Cerqueira
MC
D000410:Alanine Transaminase / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D033001:Directed Tissue Donation; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000201:enzymology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000458:organization & administration
D000410:Alanine Transaminase