Outcome of liver transplantation based on donor graft quality and recipient status.
BACKGROUND
Availability of suitable donor organs has always limited the number of liver transplantations performed. Use of marginal donor organs is an alternative to overcome organ shortage.


OBJECTIVE
To analyze the effect of various combinations of donor organ quality and recipient status on the outcome of liver transplantation.


METHODS
Data from 260 whole-liver transplantations performed between January 2003 and September 2009 were analyzed retrospectively. Study groups were established according to donor organ quality (marginal score 0-1 vs 2-5) and recipient status (Model for End-Stage Liver Disease [MELD] score <17 or >17). In patients at low risk, 102 received optimal grafts (good-to-good group [G/G], and 75 received marginal grafts (bad-to-good group [B/G]. In patients at high risk, 46 received optimal grafts (good-to-bad group [G/B], and 37 received marginal grafts (bad-to-bad group [B/B].


RESULTS
No differences were observed in cumulative patient and graft survival rates; however, total survival differed in the early period after transplantation, that is, within 1 year. There was a higher rate of overall postoperative complications including initial poor graft function, bleeding, infection, and kidney failure in group B/B compared with group G/B (25 of 37 patients [67.5%] vs 27 of 46 patients [59.0%]), group B/G (25 of 37 patients [68%] vs 39 of 75 patients [52%], and group G/G (25 of 37 patients [68%] vs 43 of 102 patients [42%]) (P = .04). Patients with a high MELD score (G/B and B/B) demonstrated increased risk of postoperative complications. Use of donor organs with marginal score of 2 or higher in patients with high MELD scores increased early patient mortality.


CONCLUSIONS
In summary, patients with a high MELD score (G/B and B/B) are at an increased risk of post-OLT complications. In contrast, use of marginal grafts (B/G and B/B) increased the rate of hepatitis C virus recurrence and decreased the response rate to antiviral therapy. The combination of impaired donor grafts and recipients at high risk should be avoided.
Nemes
B
B
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. nemes@trans.sote.hu
Gelley
F
F
Zádori
G
G
Piros
L
L
Perneczky
J
J
Kóbori
L
L
Fehérvári
I
I
Görög
D
D
D000328:Adult; D005260:Female; D006085:Graft Survival / Q000502:physiology; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000145:classification; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data* / Q000600:supply & distribution; D016896:Treatment Outcome