Donor influence on outcome in patients undergoing liver transplant for primary biliary cirrhosis.
OBJECTIVE
Risk factors for survival after liver transplant owing to primary biliary cirrhosis have been extensively investigated, whereas the donor-specific influence and particularly, the histologic data, have not been sufficiently analyzed.


METHODS
Donor data of 121 patients who underwent liver transplant for primary biliary cirrhosis and histologic findings of 69 donor liver grafts were assessed according to preoperative status and histologic criteria. Findings were correlated with the histologic and clinical course up to 20 years after orthotopic liver transplant.


RESULTS
Risk factors for death were a longer stay in intensive care units (> 7 days) (P < .02), a hypotensive period > 60 minutes (P < .03), and the administration of red blood cells (P < .04). Grafts from donors with liver fibrosis (P < .03), fatty degeneration (P < .04), and liver cell hydrops (P < .04) resulted in a significantly higher risk of primary biliary cirrhosis recurrence. Log rank analysis revealed a significant decreased survival for patients if donors had a prolonged hypotensive period (P < .02) and administration of epinephrine (P < .03) and red blood cells (P < .05).


CONCLUSIONS
Our results show that donor histology can affect disease recurrence, especially the grade of inflammation, fibrosis, and fatty degeneration. In addition, prolonged intensive care hospitalization for donors should be avoided.
Jacob
Dietmar A
DA
Department of General, Visceral and Transplantation Surgery, Humboldt University of Berlin, Germany. dr.djacob@web.de
Haase
Elena
E
Klein
Fritz
F
Pratschke
Johann
J
Neumann
Ulf P
UP
Neuhaus
Peter
P
Bahra
Marcus
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004837:Epinephrine / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000401:mortality; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
D004837:Epinephrine