title: Comparison of outcomes in ideal donor and extended criteria donor in deceased donor liver transplant: a prospective study.
abstract: BACKGROUND
  The number of patients who could benefit from liver transplantation markedly exceeds the number of available donors. This increasing gap has fuelled efforts to maximize existing donor pool and identify new avenues.
  
  
  OBJECTIVE
  To compare the outcome in deceased donor liver transplant (DDLT) based on extended donor selection criteria.
  
  
  METHODS
  Donor and recipients' data were analyzed following DDLT from Mar 2007 to Feb 2013. Donors were grouped into either ideal donor (ID) or extended criteria donor (ECD) based on donor and graft related characteristics. Primary nonfunction (PNF) and patient survival were the primary endpoints while early graft dysfunction (EGD) and incidence of major postoperative complications were the secondary endpoints of the study.
  
  
  RESULTS
  We had a total of 6 mortalities (13%) at the end of 1 year. The Kaplan Meier survival analysis at 7 days, 3, 6 and 12 months were not statistically different (p > 0.05). PNF occurred in three (6.5%) patients and was not significantly different nor influenced by cumulative number of risk factors in the subgroup analysis (p < 0.3). However, the incidence of EGD was significantly influenced by the cumulative number of risk factors (p < 0.005). A total of 12 (26.1%) patients were graded with 3 or more complications according to the 'Clavien Dindo Grade' for major post operative complications, although it did not reach a statistical significance in the various subgroups. Univariate analysis of the donor risk factors showed that none of these factors were predictive for PNF and mortality in deceased donor liver transplant recipients.
  
  
  CONCLUSIONS
  Although the incidence of early graft dysfunction is statistically more with increase in number of donor risk factors, the overall survival and outcome in extended criteria liver donors are similar to that of an ideal donor. With the supply demand gap widening, extended criteria for selection of deceased donors will definitely expand the donor pool without adversely affecting the outcome of liver transplantation.
authors.affiliation: Department of GI Surgery and Liver Transplantation, Army Hospital (Research and Referral), Delhi Cantt, New Delhi 110010, India. Electronic address: drona_routh@yahoo.co.in.
authors.forename: Dronacharya
authors.initials: D
authors.lastname: Routh
authors.affiliation: Department of GI Surgery and Liver Transplantation, Army Hospital (Research and Referral), Delhi Cantt, New Delhi 110010, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of GI Surgery and Liver Transplantation, Army Hospital (Research and Referral), Delhi Cantt, New Delhi 110010, India.
authors.forename: C S
authors.initials: CS
authors.lastname: Naidu
authors.affiliation: Department of GI Surgery and Liver Transplantation, Army Hospital (Research and Referral), Delhi Cantt, New Delhi 110010, India.
authors.forename: P P
authors.initials: PP
authors.lastname: Rao
authors.affiliation: Department of GI Surgery and Liver Transplantation, Army Hospital (Research and Referral), Delhi Cantt, New Delhi 110010, India.
authors.forename: Anuj Kumar
authors.initials: AK
authors.lastname: Sharma
authors.affiliation: Department of GI Surgery and Liver Transplantation, Army Hospital (Research and Referral), Delhi Cantt, New Delhi 110010, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Ranjan
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Extended criteria donor; Liver transplantation; Marginal donor