Combination of Extended Donor Criteria and Changes in the Model for End-Stage Liver Disease Score Predict Patient Survival and Primary Dysfunction in Liver Transplantation: A Retrospective Analysis
- 15 March 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Transplantation
- Vol. 83 (5), 588-592
- https://doi.org/10.1097/01.tp.0000255319.07499.b7
Abstract
Background. The purpose of this study was to analyze the impact of extended donor criteria (EDC) and of changes in the Model for End-Stage Liver Disease (MELD) score while waiting for liver-transplantation (Δ-MELD) on patient survival and initial graft function. Methods. We included 386 consecutive patients with end-stage liver disease who underwent orthotopic liver transplantation at the Medical University Vienna between 1997 and 2003. Primary outcome was patient survival and secondary outcome was initial graft function. EDC included: age >60 years, >4 days intensive medical care, cold ischemia time >10 hr, need for noradrenalin >0.2 μg/kg/min or doputamin >6 μg/kg/min, a donor peak serum sodium >155 mEq/L, a donor serum creatinine >1.2 mg/100 mL, and a body mass index >30. Results. Δ-MELD was significantly higher in the nonsurvivor population (P=0.01) and EDC showed a significant influence on initial graft function (P=0.01). Worsening in either Δ-MELD or the presence of at least two EDC was not associated with an increased risk of primary graft dysfunction and death. Worsening in Δ-MELD and the presence of at least two EDC was significantly associated with primary graft dysfunction (P=0.01) and death (P=0.008). Conclusion. The combination of a liver recipient with worsening Δ-MELD and a potential donor with at least two EDC should be avoided.This publication has 20 references indexed in Scilit:
- Can the use of marginal liver donors change recipient survival rate?Transplantation Proceedings, 2004
- The utility of marginal donors in liver transplantationLiver Transplantation, 2003
- Optimizing the use of donated cadaver livers: Analysis and policy development to increase the application of split-liver transplantationLiver Transplantation, 2002
- Influence of marginal donors on liver preservation injuryTransplantation, 2002
- PREOPERATIVE FACTORS ASSOCIATED WITH OUTCOME AND THEIR IMPACT ON RESOURCE USE IN 1148 CONSECUTIVE PRIMARY LIVER TRANSPLANTSTransplantation, 2001
- THE IMPACT OF DONOR AGE ON LIVER TRANSPLANTATION: INFLUENCE OF DONOR AGE ON EARLY LIVER FUNCTION AND ON SUBSEQUENT PATIENT AND GRAFT SURVIVALTransplantation, 2001
- Use of high-risk liver donors for urgent and elective liver transplantationTransplantation Proceedings, 1999
- Experience With Liver And Kidney Allografts From Non-Heart-Beating DonorsTransplantation, 1995
- RISK FACTORS FOR PRIMARY DYSFUNCTION AFTER LIVER TRANSPLANTATION—A MULTIVARIATE ANALYSISTransplantation, 1993
- PRIMARY NONFUNCTION OF HEPATIC ALLOGRAFTS WITH PREEXISTING FATTY INFILTRATION1Transplantation, 1989