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The impact of major extended donor criteria on graft failure and patient mortality after liver transplantation

IntroductionNumerous extended donor criteria (EDC) have been identified in liver transplantation (LT), but different EDC have different impacts on graft and patient survival. This study aimed to identify major EDC (maEDC) that were best able to predict the outcome after LT and to examine the plausib...

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Hauptverfasser: Lozanovski, Vladimir J. (VerfasserIn) , Khajeh, Elias (VerfasserIn) , Fonouni, Hamidreza (VerfasserIn) , Pfeiffenberger, Jan (VerfasserIn) , Haken, Rebecca von (VerfasserIn) , Brenner, Thorsten (VerfasserIn) , Mieth, Markus (VerfasserIn) , Schirmacher, Peter (VerfasserIn) , Michalski, Christoph (VerfasserIn) , Weiss, Karl Heinz (VerfasserIn) , Büchler, Markus W. (VerfasserIn) , Mehrabi, Arianeb (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: [September 2018]
In: Langenbeck's archives of surgery
Year: 2018, Jahrgang: 403, Heft: 6, Pages: 719-731
ISSN:1435-2451
DOI:10.1007/s00423-018-1704-z
Online-Zugang:Verlag, Volltext: https://doi.org/10.1007/s00423-018-1704-z
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Verfasserangaben:Vladimir J. Lozanovski, Elias Khajeh, Hamidreza Fonouni, Jan Pfeiffenberger, Rebecca von Haken, Thorsten Brenner, Markus Mieth, Peter Schirmacher, Christoph W. Michalski, Karl Heinz Weiss, Markus W. Büchler, Arianeb Mehrabi
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Zusammenfassung:IntroductionNumerous extended donor criteria (EDC) have been identified in liver transplantation (LT), but different EDC have different impacts on graft and patient survival. This study aimed to identify major EDC (maEDC) that were best able to predict the outcome after LT and to examine the plausibility of an allocation algorithm based on these criteria.MethodsAll consecutive LTs between 12/2006 and 03/2014 were included (n = 611). We analyzed the following EDC: donor age > 65 years, body mass index > 30, malignancy and drug abuse history, intensive care unit stay/ventilation > 7 days, aminotransferases > 3 times normal, serum bilirubin > 3 mg/dL, serum Na+ > 165 mmol/L, positive hepatitis serology, biopsy-proven macrovesicular steatosis (BPS) > 40%, and cold ischemia time (CIT) > 14 h. We analyzed hazard risk ratios of graft failure for each EDC and evaluated primary non-function (PNF). In addition, we analyzed 30-day, 90-day, 1-year, and 3-year graft survival. We established low- and high-risk graft (maEDC 0 vs. ≥ 1) and recipient (labMELD < 20 vs. ≥ 20) groups and compared the post-LT outcomes between these groups.ResultsBPS > 40%, donor age > 65 years, and CIT > 14 h (all p < 0.05) were independent predictors of graft failure and patient mortality and increased PNF, 30-day, 90-day, 1-year, and 3-year graft failure rates. Three-year graft and patient survival decreased in recipients of ≥ 1 maEDC grafts (all p < 0.05) and LT of high-risk grafts into high-risk recipients yielded worse outcomes compared with other groups.ConclusionDonor age > 65 years, BPS > 40%, and CIT > 14 h are major EDC that decrease short and 3-year graft survival, and 3-year patient survival. An allocation algorithm based on maEDC and labMELD is therefore plausible.
Beschreibung:Gesehen am 16.07.2019
Beschreibung:Online Resource
ISSN:1435-2451
DOI:10.1007/s00423-018-1704-z

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