Application of extended criteria donor grafts in liver transplantation for acute-on-chronic liver failure: A retrospective cohort study

A Review of Long-Term Outcomes of Liver Transplantation Using Extended Criteria Donors in the United States

INTRODUCTION

Utilizing the marginal livers for transplantation has gained more attention recently, but there are still some doubts regarding the outcomes. This study focuses on the outcomes of extended criteria donor liver transplants (LTs) in the United States, in order to assess the feasibility of these types of livers utilization.

MATERIALS AND METHODS

A retrospective registry analysis of the Organ Procurement and Transplantation Network/United Network for Organ Sharing database was done for LTs that were performed in the United States from January 2001 to April 2020.

RESULTS

The study divided into two subgroups, based on the transplantation year; patients who received an LT from January 2001 until the end of December 2010 (n = 50,928), and those who received an LT, from January 2011 to April 2020 (n = 59,643). The data analysis showed a significant overall 10-y graft survival improvement in the 2011-2020 group compared to the 2001-2010 group, from a mean of 58% in 2001-2010 to a mean of 68% in 2011-2020 (P < 0.001). Not only the overall 10-y graft survival has improved in the 2011-2020 group but also the graft survival has significantly improved in the extended criteria donors (ECDs) group compared to the 2001-2010 cohort, in which the 10-y graft survival is even higher in the 2011-2020 ECD group than non-ECD group in 2001-2010.

CONCLUSIONS

With all the surgical techniques and postoperation improvements, ECD livers can prove to be a meaningful solution to overcome long waiting times and current underutilization in order to improve the short- and long-term quality of life in the patients who are in need of liver transplant.

Liver stiffness: a novel imaging biomarker by ultrasound elastography for prediction of early allograft failure following liver transplantation

OBJECTIVES

The objective of this study was to evaluate the role of Liver Stiffness Measurement (LSM) and serum transaminase levels for predicting early allograft failure (EAF) after liver transplantation (LT).

METHODS

A total of 189 patients who underwent LT were prospectively recruited in the study. Of these patients, 13 cases died or received re-transplantation within 90 days after surgery were classified as EAF group, while rest 176 patients were included in the non-EAF group. LSM values and serum transaminase levels within 1 week after operation were recorded and compared between two groups. The area under the curve (AUC) was utilized to assess the performance of LSM, serum transaminase and their combination in predicting EAF.

RESULTS

The earliest significant difference in LSM between EAF and non-EAF group was observed on postoperative day 3 (POD-3) (p = 0.046). Comparing to non-EAF group, patients in the EAF group had higher aspartate-aminotransferase (AST) and alanine aminotransferase (ALT) on postoperative day 2 (POD-2)(p = 0.009, 0.033), and also demonstrated higher AST on POD-3 (p = 0.021). Furthermore, the reduction rate of AST/ALT from day 1 to day 3 (AST/ALT Red) were slower (p = 0.001, 0.014) in EAF group. Using a LSM value > 12.1 kPa and an AST level > 339U/L on POD-3 predicted EAF with a sensitivity of 89%, a specificity of 86%, and an AUC of 0.926, surpassing the traditional early allograft dysfunction (EAD) model.

CONCLUSIONS

The combination of LSM values and AST levels on the third day after LT can effectively predict EAF and facilitate timely interventions.

Advancements in Predictive Tools for Primary Graft Dysfunction in Liver Transplantation: A Comprehensive Review

Orthotopic liver transplantation stands as the sole curative solution for end-stage liver disease. Nevertheless, the discrepancy between the demand and supply of grafts in transplant medicine greatly limits the success of this treatment. The increasing global shortage of organs necessitates the utilization of extended criteria donors (ECD) for liver transplantation, thereby increasing the risk of primary graft dysfunction (PGD). Primary graft dysfunction (PGD) encompasses early allograft dysfunction (EAD) and the more severe primary nonfunction (PNF), both of which stem from ischemia-reperfusion injury (IRI) and mitochondrial damage. Currently, the only effective treatment for PNF is secondary transplantation within the initial post-transplant week, and the occurrence of EAD suggests an elevated, albeit still uncertain, likelihood of retransplantation urgency. Nonetheless, the ongoing exploration of novel IRI mitigation strategies offers hope for future improvements in PGD outcomes. Establishing an intuitive and reliable tool to predict upcoming graft dysfunction is vital for early identification of high-risk patients and for making informed retransplantation decisions. Accurate diagnostics for PNF and EAD constitute essential initial steps in implementing future mitigation strategies. Recently, novel methods for PNF prediction have been developed, and several models for EAD assessments have been introduced. Here, we provide an overview of the currently scrutinized predictive tools for PNF and EAD evaluation strategies, accompanied by recommendations for future studies.