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Watanabe ALC, Feijó MS, Menezes VPLD, Galdino-Vasconcelos MR, Caballero JLS, Ferreira G, Jorge F, Trevizoli N, Diaz LG, Campos PBD, Cajá G, Ullmann R, Figueira AV, Morato T, Moraes A, Pereira JRB, Perosa M. 500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil. Transplant Proc 2021; 53:73-82. [PMID: 32981691 DOI: 10.1016/j.transproceed.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Liver transplantation is the standard treatment for end-stage liver disease. Brazil holds the third highest number of liver transplants performed per year, but center maldistribution results in high discrepancies in accessing this treatment. In 2012, an interstate partnership successfully implemented a new liver transplantation program in the middle west of Brazil. Here, we report the results of the first 500 liver transplants performed in this new program and discuss the impacts of a new transplant center in regional transplantation dynamics. METHODS We reviewed data from the first 500 consecutive deceased donor liver transplants performed in the new program during an 8-year period. We analyzed data on patients' clinical and demographic profiles, postoperative outcomes, and graft and recipient survival rates. Univariate survival analysis was conducted using log-rank tests to compare the groups. RESULTS Almost half (48%) of the procured organs and 40% of the recipients transplanted in our center were from outside our state. Recipient 30-day mortality was 9%. Overall recipient survival at 1 year and 5 years was 85% and 80%, respectively. Mortality was significantly associated with higher Model for End-Stage Liver Disease (P < .001) but not with the presence of hepatocellular carcinoma (P = .795). DISCUSSION The new transplantation program treated patients from different regions of Brazil and became the reference center in liver transplantation for the middle west region. Despite the recent implementation, our outcomes are comparable to experienced centers around the world. This model can inspire the creation of new transplantation programs aiming to democratize access to liver transplantation nationwide.
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Affiliation(s)
- André Luís Conde Watanabe
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Mateus Silva Feijó
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil.
| | | | | | - Jorge Luis Salinas Caballero
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | - Gustavo Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Fernando Jorge
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Natália Trevizoli
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Luiz Gustavo Diaz
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Priscila Brizolla de Campos
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Gabriel Cajá
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Raquel Ullmann
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Ana Virgínia Figueira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Tiago Morato
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Adriano Moraes
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Juan Rafael Branez Pereira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Marcelo Perosa
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
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Watanabe ALC, Feijó MS, Menezes VPLD, Galdino-Vasconcelos MR, Caballero JLS, Ferreira G, Jorge F, Trevizoli N, Diaz LG, Campos PBD, Cajá G, Ullmann R, Figueira AV, Morato T, Moraes A, Pereira JRB, Perosa M. 500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil. Transplant Proc 2021; 53:73-82. [DOI: https:/doi.org/10.1016/j.transproceed.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Nemes B, Gámán G, Polak WG, Gelley F, Hara T, Ono S, Baimakhanov Z, Piros L, Eguchi S. Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors. Expert Rev Gastroenterol Hepatol 2016; 10:827-39. [PMID: 26838962 DOI: 10.1586/17474124.2016.1149061] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The definition and factors of extended criteria donors have already been set; however, details of the various opinions still differ in many respects. In this review, we summarize the impact of these factors and their clinical relevance. Elderly livers must not be allocated for hepatitis C virus (HCV) positives, or patients with acute liver failure. In cases of markedly increased serum transaminases, donor hemodynamics is an essential consideration. A prolonged hypotension of the donor does not always lead to an increase in post-transplantation graft loss if post-OLT care is proper. Hypernatremia of less than 160 mEq/L is not an absolute contraindication to accept a liver graft per se. The presence of steatosis is an independent and determinant risk factor for the outcome. The gold standard of the diagnosis is the biopsy. This is recommended in all doubtful cases. The use of HCV+ grafts for HCV+ recipients is comparable in outcome. The leading risk factor for HCV recurrence is the actual RNA positivity of the donor. The presence of a proper anti-HBs level seems to protect from de novo HBV infection. A favourable outcome can be expected if a donation after cardiac death liver is transplanted in a favourable condition, meaning, a warm ischemia time < 30 minutes, cold ischemia time < 8-10 hours, and donor age 50-60 years. The pathway of organ quality assessment is to obtain the most relevant information (e.g. biopsy), consider the co-existing donor risk factors and the reserve capacity of the recipient, and avoid further technical issues.
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Affiliation(s)
- Balázs Nemes
- a Department of Organ Transplantation, Faculty of Medicine , Institute of Surgery, University of Debrecen , Debrecen , Hungary
| | - György Gámán
- b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Wojciech G Polak
- c Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC , University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fanni Gelley
- d Department of Internal medicine and Gastroenterology , Polyclinic of Hospitallers Brothers of St. John of God , Budapest , Hungary
| | - Takanobu Hara
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Shinichiro Ono
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Zhassulan Baimakhanov
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Laszlo Piros
- b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Susumu Eguchi
- e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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Kaseje N, McLin V, Toso C, Poncet A, Wildhaber BE. Donor hypernatremia before procurement and early outcomes following pediatric liver transplantation. Liver Transpl 2015; 21:1076-81. [PMID: 25902852 DOI: 10.1002/lt.24145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 01/13/2023]
Abstract
The demand for transplantable organs far outweighs the supply. Recently, efforts have been made to increase the donor pool by adopting extended criteria for livers, including those from hypernatremic donors. Currently, there is no clear evidence that the use of organs from hypernatremic donors has detrimental effects on pediatric liver transplantation (LT) recipients. Our aim was to use the Scientific Registry of Transplant Recipients database to evaluate the effects of donor hypernatremia on 30-day outcomes in pediatric LT recipients. We performed an analysis of 2325 children who underwent whole or partial LT between 2005 and 2010. First, we sought to determine a donor sodium threshold for increased mortality following pediatric LT. Second, we examined rates of mortality and graft failure at 30 days after LT in patients receiving grafts from hypernatremic donors compared to patients receiving grafts from normonatremic donors. Hypernatremia was defined as a donor sodium level of ≥160 µmol/L. The primary outcome measure was mortality at 30 days after transplant. The secondary outcome measure was graft failure at 30 days after transplant. There was no threshold sodium level for increased 30-day mortality following pediatric LT. Mean recipient ages/weights, Pediatric End-Stage Liver Disease/Model for End-Stage Liver Disease scores, and mean cold and warm ischemia times were similar between the 2 study groups. There were no significant differences in mortality rates (3.9% versus 4.5%; P = 0.87) and graft failure rates (2.2% versus 1.9%; P = 1.00) in patients receiving grafts from hypernatremic donors compared to patients receiving grafts from normonatremic donors at 30 days after LT. In conclusion, donor hypernatremia just before procurement does not appear to have negative effects on mortality and graft failure rates at 30 days following pediatric LT.
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Affiliation(s)
- Neema Kaseje
- Divisions of Pediatric Surgery, University Hospitals Geneva, Geneva, Switzerland
| | - Valerie McLin
- Division of Pediatrics, University Hospitals Geneva, Geneva, Switzerland
| | - Christian Toso
- Division of Surgery, University Hospitals Geneva, Geneva, Switzerland
| | - Antoine Poncet
- Division of Center for Epidemiology, University Hospitals Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- Divisions of Pediatric Surgery, University Hospitals Geneva, Geneva, Switzerland
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