title: The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis.
abstract: Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use.
  
  
  
  The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002-2014). Cox hazards models were created using (1) United Network for Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure.
  
  
  
  A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9%) patients received an ECD. Transplantation with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.91-1.23) between donor types but an increased risk of graft failure (HR 1.18, 95% CI 1.03-1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10% increase in KDPI was associated with a 28% increase in patient mortality (HR 1.28, 95% CI 1.02-1.60) and 45% increase in graft failure (HR 1.45, 95% CI 1.18-1.80).
  
  
  
  Based on the current United Network for Organ Sharing definition, ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of South Florida, Tampa, FL. Electronic address: fdimou@health.usf.edu.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Dimou
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Hemalkumar B
authors.initials: HB
authors.lastname: Mehta
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Deepak
authors.initials: D
authors.lastname: Adhikari
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Harland
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D046148:Donor Selection; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States