title: Effects of graft quality on non-urgent liver retransplantation survival: should we avoid high-risk donors?
abstract: BACKGROUND
  Few studies have studied the effects of graft quality on non-urgent liver retransplantation (ReLT) outcomes. We aimed to analyze graft characteristics and survival in non-urgent ReLT and the effect of using grafts with extended criteria on survival.
  
  
  METHODS
  Eighty non-urgent ReLT were performed from June 1988 to June 2010. The whole series was divided by identical time periods to study time-related effects. We assessed graft quality with donor risk index (DRI) and Briceño scores and recipient status with the Model for End-stage Liver Diseases and Rosen scores. Low and high-risk grafts were defined by a DRI cutoff of 1.8.
  
  
  RESULTS
  Graft survival was similar in both periods (1-, 5-, and 10-year graft survivals: 73.5, 46.9, and 40.8 versus 71, 47.7, and 47.7%, p=0.935) although donor quality was worse in the second period (DRI: 1.35±0.32 vs. 1.66±0.34, p<0.001). In the first period high-risk grafts did worse than low-risk grafts (5-year survival: 0 vs. 54.5%, p=0.002) while in the second period outcomes were similar (5-year survival: 48.6 vs. 56.7%, p=0.660). Donor age was the only independent donor factor for graft survival, with lower survival when using grafts from donors over 60-years-old.
  
  
  CONCLUSIONS
  Graft quality in ReLT has worsened with time mainly because of older donors but nowadays the use of high-risk grafts in non-urgent ReLT is not associated with worse graft survival because of better perioperative management. Moreover of being selective on recipient conditions, care should be taken when using grafts from donors over 60-years-old for non-urgent ReLT.
authors.affiliation: Liver Surgery and Transplantation Unit, Institut de Malalties Digestives i Metabòliques, IDIBAPS, Hospital Clínic i Provincial, CIBERehd, University of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Marti
authors.forename: Josep
authors.initials: J
authors.lastname: Fuster
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
authors.forename: Antoni
authors.initials: A
authors.lastname: Rimola
authors.forename: Amalia
authors.initials: A
authors.lastname: Pelegrina
authors.forename: Constantino
authors.initials: C
authors.lastname: Fondevila
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Valdecasas
mesh_terms: D000328:Adult; D000367:Age Factors; D046148:Donor Selection / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors