title: Futility Versus Acceptability of the Use of Grafts Taken From End of Line in the National Organ-Sharing Network.
abstract: BACKGROUND
  The number of suitable donors for organ transplantation is limited in many countries. This limitation can be overcome with the use of organs removed from marginal donors (expanded-criteria donors [ECDs]). We examined the long-term results of 187 patients who underwent marginal cadaveric liver transplantation in our institution.
  
  
  METHODS
  The data of patients who underwent cadaveric liver transplantation from January 2007 to April 2014 were retrospectively reviewed. ECDs were evaluated by considering 19 internationally accepted criteria. The clinical data of recipients including age, clinical status, and Model for End-Stage Liver Disease (MELD) score were also assessed.
  
  
  RESULTS
  A total of 287 patients underwent cadaveric liver transplantation. A graft from an ECD was used in 181 (63.06%) patients. The mean MELD score was 18.8. In all, 45 patients (24.86%) underwent transplantations for fulminant liver failure and 136 patients (75.14%) underwent transplantations for other chronic conditions. The majority of donors died of cerebrovascular disease and trauma. Only hypotension requiring inotropic drugs and obesity significantly affected survival. The 90-day and 12-month survival rates of the recipients who received a graft from an ECD were 51.93% and 46.2%, respectively.
  
  
  CONCLUSIONS
  The use of ECD allografts immediately and significantly expands the existing donor pool. Because of persistent organ scarcity, pressure to use a greater proportion of the existing donor pool will continue to increase.
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey. Electronic address: hvuralsoyer@yahoo.com.
authors.forename: V
authors.initials: V
authors.lastname: Soyer
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Koc
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Onur
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Sarıcı
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Isık
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Unal
authors.affiliation: Department of Biostatistics and Medical Information, Inonu University, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yologlu
authors.affiliation: Department of General Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000401:mortality; D014421:Turkey; D055815:Young Adult