Favorable outcome of orthotopic liver transplantation in very high-risk situations.
BACKGROUND
Favorable outcomes of marginal liver grafts depends on optimal perioperative control and good recipient parameters. The aim of this study was to assess the results of marginal liver grafts associated with prolonged ischemic times and high-risk recipients.


METHODS
We retrospectively reviewed data from patients who underwent orthotopic liver transplantation between 2001 and 2005. The patients were divided into two groups: group 1 received marginal liver grafts with ischemia times >or= 12 hours and recipient United Network for Organ Sharing (UNOS) status 1, 2A, and 2B. Patients who had marginal liver grafts with ischemic times less than 12 hours and/or better UNOS status were classified as group 2. We compared initial graft function as well as patient and graft survivals at 1 year between the two groups.


RESULTS
Among 31 patients who were reviewed, four were excluded because of incomplete data and 24/27 received marginal liver grafts. Seven patients were classified into group 1, and 17 into group 2. The initial poor function rate was 85.7% (6/7 patients) and 76.47% (13/17 patients) in groups 1 and 2, respectively. The 1-year survival rate in group 1 was 85.7% (6/7 patients) and 94.12% (16/17 patients) in group 2.


CONCLUSIONS
Marginal liver grafts can be used with favorable outcomes even in high-risk situations, such as prolonged ischemia times and high-risk recipients.
Nonthasoot
B
B
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Tongyoo
A
A
Sirichindakul
B
B
Nivatvongs
S
S
Suphapol
J
J
Leelanukrom
R
R
Poonyathawon
S
S
Burimsittichai
R
R
Wisedopas
N
N
Komolmit
P
P
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001926:Brain Death; D002316:Cardiotonic Agents / Q000009:adverse effects; D002648:Child; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012964:Sodium / Q000097:blood; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D055815:Young Adult
D002316:Cardiotonic Agents; D012964:Sodium; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase