Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival
Alfred J. Tector, III, MD, PhD*, Richard Shane Mangus, MD*, Paul Chestovich, MD*, Rodrigo M. Vianna, MD*, Jonathan A. Fridell, MD*, Martin L. Milgrom, MD*, Carrie E. Sanders, BN*, Paul Y. Kwo, MD*
Indiana University, Indanapolis, IN
Sponsored by: Keith Lillemoe, MD
OBJECTIVE(S): The use of extended criteria donors (ECD) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors This study compares the graft/patient survival from standard (SD) and ECD for our transplant population between 2001 and 2005.
METHODS: Records of all adult liver transplant recipients over 4 years were reviewed (n=571). ECD criteria included: age > 59 years, BMI > 34.9, maximum AST/ALT > 500, maximum bilirubin > 2.0, peak serum sodium > 170, HBV/HCV/HTLV reactive, non-heart beating donor, cold ischemia time > 12 hours, ICU stay > 5 days, more than 2 pressors simultaneously, extensive alcohol abuse, cancer history (non-skin), active meningitis/bacteremia or significant donor liver trauma. Outcomes included graft and patient survival at 90-days, 1-year and 2-years.
RESULTS: Sixty-eight percent of recipients (n=388) received ECD livers. Primary factors accounting for ECD-liver status included: elevated LFTs (20%), hypernatremia (12.6%), and extensive alcohol abuse (11.4%). Graft survival was (SD, ECD): 90-day 91%, 88%; 1-year 84%, 80%; 2-year 78%, 77%; patient survival was: 90-day 93%, 90%; 1-year 87%, 82%; 2-year 83%, 79%. Kaplan-Meier survival analysis failed to demonstrate an overall difference in graft or patient survival at any time point.
CONCLUSIONS: Liver grafts from ECD can be used to dramatically reduce waitlist time with outcomes comparable to those for SD without resorting to living donor liver transplantation.
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