The difficulty in defining extended donor criteria for liver grafts: the Eurotransplant experience.
Donor criteria for liver grafts have been expanded because of organ shortage. Currently, no exact definitions for extended donor grafts have been established. The aim of this study was to analyze the impact of donor-specific risk factors, independent of recipient characteristics. In collaboration with Eurotransplant and European Liver Transplant Register, solely donor-specific parameters were correlated with 1-year survival following liver transplantation. Analyses of 4701 donors between 2000 and 2005 resulted in the development of a nomogram to estimate graft survival for available grafts. Predictions by nomogram were compared to those by Donor Risk Index (DRI). In the multivariate analysis, cold ischemic time (CIT), highest sodium, cause of donor death, γ-glutamyl transferase (γ-GT), and donor sex (female) were statistically significant factors for 3 months; CIT, γ-GT, and cause of donor death for 12-month survival. The median DRI of this study population was 1.45 (Q1: 1.17; Q3: 1.67). The agreement between the nomogram and DRI was weak (kappa = 0.23). Several donor-specific risk factors were identified for early survival after liver transplantation. The provided nomogram will support quick organ quality assessment. Nevertheless, this study showed the difficulties of determining an exact definition of extended criteria donors.
Department of Transplant Surgery, Medical University Vienna, Vienna, Austria.
Gerd R
GR
Silberhumer
Axel
A
Rahmel
Vincent
V
Karam
Mithat
M
Gonen
Georg
G
Gyoeri
Barbara
B
Kern
Rene
R
Adam
Ferdinand
F
Muehlbacher
Xavier
X
Rogiers
Andrew K
AK
Burroughs
Gabriela A
GA
Berlakovich
D000328:Adult; D050377:Cold Ischemia; D005060:Europe; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D014850:Waiting Lists; D005723:gamma-Glutamyltransferase / Q000378:metabolism
D005723:gamma-Glutamyltransferase
donor evaluation; extended liver donor criteria; liver transplantation; organ quality