1
|
Cherchi V, Vetrugno L, Terrosu G, Deana C, Ventin M, Zanini V, Barbariol F, Pravisani R, Bove T, Risaliti A, Lorenzin D, Baccarani U. Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study. Clin Transplant 2023; 37:e15034. [PMID: 37212369 DOI: 10.1111/ctr.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The role of nutrition in donor after brain deaths (DBDs) has yet to be adequately discussed. The primary aim of this study was to investigate whether the nutritional intake in the 48 h before organ retrieval may play a role on the graft functional recovery assessed with Model for Early Allograft Function (MEAF) Score. METHODS Single-center retrospective study evaluating all liver transplants performed at the University Hospital of Udine from January 2010 to August 2020. Patients receiving grafts from DBD donors fed with artificial enteral nutrition in the 48 h prior to organ procurement (EN-group) or who did not (No-EN-group). Caloric debt was calculated using the difference between the calculated caloric needs and the effective calories delivered through enteral nutrition. RESULTS Livers from EN-group presented a lower mean MEAF score compared to the no-EN-group: 3.39 ± 1.46 versus 4.15 ± 1.51, respectively (p = .04). A positive correlation between caloric debt and the MEAF score was found within the overall population (r = .227, p = .043) as well as in EN-group (r = .306, p = .049). CONCLUSIONS Donor's nutritional intake in the final 48 h before organ procurement correlates with MEAF score, and nutrition probably plays a positive role on the functional recovery of the graft. Large future randomized controlled trials are needed to confirm this preliminary results.
Collapse
Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| |
Collapse
|
2
|
Lai Q, Melandro F, Manzia TM, Spoletini G, Crovetto A, Gallo G, Hassan R, Mennini G, Angelico R, Avolio AW, Berrevoet F, Abreu de Carvalho L, Agnes S, Tisone G, Rossi M. The Role of Donor Gamma-Glutamyl Transferase as a Risk Factor for Early Graft Function after Liver Transplantation. J Clin Med 2023; 12:4744. [PMID: 37510859 PMCID: PMC10380680 DOI: 10.3390/jcm12144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Growing interest has been recently reported in the potential detrimental role of donor gamma-glutamyl transferase (GGT) peak at the time of organ procurement regarding the risk of poor outcomes after liver transplantation (LT). However, the literature on this topic is scarce and controversial data exist on the mechanisms justifying such a correlation. This study aims to demonstrate the adverse effect of donor GGT in a large European LT cohort regarding 90-day post-transplant graft loss. METHODS This is a retrospective international study investigating 1335 adult patients receiving a first LT from January 2004 to September 2018 in four collaborative European centers. RESULTS Two different multivariable logistic regression models were constructed to evaluate the risk factors for 90-day post-transplant graft loss, introducing donor GGT as a continuous or dichotomous variable. In both models, donor GGT showed an independent role as a predictor of graft loss. In detail, the log-transformed continuous donor GGT value showed an odds ratio of 1.46 (95% CI = 1.03-2.07; p = 0.03). When the donor GGT peak value was dichotomized using a cut-off of 160 IU/L, the odds ratio was 1.90 (95% CI = 1.20-3.02; p = 0.006). When the graft-loss rates were investigated, significantly higher rates were reported in LT cases with donor GGT ≥160 IU/L. In detail, 90-day graft-loss rates were 23.2% vs. 13.9% in patients with high vs. low donor GGT, respectively (log-rank p = 0.004). Donor GGT was also added to scores conventionally used to predict outcomes (i.e., MELD, D-MELD, DRI, and BAR scores). In all cases, when the score was combined with the donor GGT, an improvement in the model accuracy was observed. CONCLUSIONS Donor GGT could represent a valuable marker for evaluating graft quality at transplantation. Donor GGT should be implemented in scores aimed at predicting post-transplant clinical outcomes. The exact mechanisms correlating GGT and poor LT outcomes should be better clarified and need prospective studies focused on this topic.
Collapse
Affiliation(s)
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umbertot I of Rome, 00185 Rome, Italy
| | - Fabio Melandro
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umbertot I of Rome, 00185 Rome, Italy
| | - Tommaso M Manzia
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Crovetto
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, 9000 Ghent, Belgium
| | - Gaetano Gallo
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umbertot I of Rome, 00185 Rome, Italy
| | - Redan Hassan
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umbertot I of Rome, 00185 Rome, Italy
| | - Gianluca Mennini
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umbertot I of Rome, 00185 Rome, Italy
| | - Roberta Angelico
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Alfonso W Avolio
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, 9000 Ghent, Belgium
| | - Luís Abreu de Carvalho
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, 9000 Ghent, Belgium
| | - Salvatore Agnes
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00173 Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umbertot I of Rome, 00185 Rome, Italy
| |
Collapse
|
3
|
Kim JJ, Curtis RMK, Reynolds B, Marks S, Drage M, Kosmoliaptsis V, Dudley J, Williams A. The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients. Front Immunol 2023; 14:1207145. [PMID: 37334377 PMCID: PMC10275486 DOI: 10.3389/fimmu.2023.1207145] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background The UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry. Methods We performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (<18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival >30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021. Results 319/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p<0.001], recipient minority ethnic group [1.28(1.01-1.63), p<0.05), dialysis before transplant [1.38(1.04-1.81), p<0.005], donor height [0.99 (0.98-1.00) per centimetre, p<0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p<0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0/1 B mismatch) had median graft survival >17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05]. Summary Adult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.
Collapse
Affiliation(s)
- Jon Jin Kim
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Rebecca M. K. Curtis
- Statistics and Clinical Research, NHS Blood and Transplant, Bristol, United Kingdom
| | - Ben Reynolds
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Martin Drage
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom
| | - Jan Dudley
- Department of Paediatric Nephrology, Bristol Children’s Hospital, Bristol, United Kingdom
| | - Alun Williams
- Department of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United Kingdom
| |
Collapse
|
4
|
Asrani SK, Saracino G, Wall A, Trotter JF, Testa G, Hernaez R, Sharma P, Kwong A, Banerjee S, McKenna G. Assessment of donor quality and risk of graft failure after liver transplantation: The ID 2 EAL score. Am J Transplant 2022; 22:2921-2930. [PMID: 36053559 DOI: 10.1111/ajt.17191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/19/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
Accurate assessment of donor quality at the time of organ offer for liver transplantation candidates may be inadequately captured by the donor risk index (DRI). We sought to develop and validate a novel objective and simple model to assess donor risk using donor level variables available at the time of organ offer. We utilized national data from candidates undergoing primary LT (2013-2019) and assessed the prediction of graft failure 1 year after LT. The final components were donor Insulin-dependent diabetes mellitus, Donor type (DCD or DBD), cause of Death = CVA, serum creatinine, Age, height, and weight (length). The ID2 EAL score had better discrimination than DRI using bootstrap corrected concordant index over time, especially in the current era. We explored donor-recipient matching. Relative risk of graft failure ranged from 1.15 to 3.5 based on relevant donor-recipient matching by the ID2 EAL score. As an example, for certain recipients, a young DCD donor offer was preferable to an older DBD with relevant comorbidities. The ID2 EAL score may serve as an important tool for patient discussion about donor risk and decisions regarding offer acceptance. In addition, the score may be preferable to succinctly capture donor risk in future organ allocation that considers continuous distribution (www.iddealscore.com).
Collapse
Affiliation(s)
- Sumeet K Asrani
- Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA
| | - Giovanna Saracino
- Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA
| | - Anji Wall
- Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA
| | - James F Trotter
- Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA
| | - Giuliano Testa
- Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA
| | | | | | - Allison Kwong
- Stanford University, Division of Gastroenterology and Hepatology, Stanford, California, USA
| | - Srikanta Banerjee
- School of Health Sciences, Walden University, Minneapolis, Minnesota, USA
| | - Gregory McKenna
- Baylor University Medical Center, Baylor Scott and White Heath, Dallas, Texas, USA
| |
Collapse
|
5
|
Chan E, Logan AJ, Sneddon JM, Singh N, Brock GN, Washburn WK, Schenk AD. Dynamic impact of liver allocation policy change on donor utilization. Am J Transplant 2022; 22:1901-1908. [PMID: 35182000 PMCID: PMC9544006 DOI: 10.1111/ajt.17006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 01/25/2023]
Abstract
Liver allocation policy was changed to reduce variance in median MELD scores at transplant (MMaT) in February 2020. "Acuity circles" replaced local allocation. Understanding the impact of policy change on donor utilization is important. Ideal (I), standard (S), and non-ideal (NI) donors were defined. NI donors include older, higher BMI donors with elevated transaminases or bilirubin, history of hepatitis B or C, and all DCD donors. Utilization of I, S, and NI donors was established before and after allocation change and compared between low MELD (LM) centers (MMaT ≤ 28 before allocation change) and high MELD (HM) centers (MMaT > 28). Following reallocation, transplant volume increased nationally (67 transplants/center/year pre, 74 post, p .0006) and increased for both HM and LM centers. LM centers significantly increased use of NI donors and HM centers significantly increased use of I and S donors. Centers further stratify based on donor utilization phenotype. A subset of centers increased transplant volume despite rising MMaT by broadening organ acceptance criteria, increasing use of all donor types including DCD donors (98% increase), increasing living donation, and transplanting more frequently for alcohol associated liver disease. Variance in donor utilization can undermine intended effects of allocation policy change.
Collapse
Affiliation(s)
- Ethan Chan
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| | - April J. Logan
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Jeffrey M. Sneddon
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Navdeep Singh
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Guy N. Brock
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| | - William K. Washburn
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Austin D. Schenk
- Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhio
| |
Collapse
|
6
|
Zhang S, Suen SC, Gong CL, Pham J, Trebicka J, Duvoux C, Klein AS, Wu T, Jalan R, Sundaram V. Early transplantation maximizes survival in severe acute-on-chronic liver failure: Results of a Markov decision process model. JHEP Rep 2021; 3:100367. [PMID: 34825154 PMCID: PMC8603202 DOI: 10.1016/j.jhepr.2021.100367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022]
Abstract
Background & Aims Uncertainties exist surrounding the timing of liver transplantation (LT) among patients with acute-on-chronic liver failure grade 3 (ACLF-3), regarding whether to accept a marginal quality donor organ to allow for earlier LT or wait for either an optimal organ offer or improvement in the number of organ failures, in order to increase post-LT survival. Methods We created a Markov decision process model to determine the optimal timing of LT among patients with ACLF-3 within 7 days of listing, to maximize overall 1-year survival probability. Results We analyzed 6 groups of candidates with ACLF-3: patients age ≤60 or >60 years, patients with 3 organ failures alone or 4-6 organ failures, and hepatic or extrahepatic ACLF-3. Among all groups, LT yielded significantly greater overall survival probability vs. remaining on the waiting list for even 1 additional day (p <0.001), regardless of organ quality. Creation of 2-way sensitivity analyses, with variation in the probability of receiving an optimal organ and expected post-transplant mortality, indicated that overall survival is maximized by earlier LT, particularly among candidates >60 years old or with 4-6 organ failures. The probability of improvement from ACLF-3 to ACLF-2 does not influence these recommendations, as the likelihood of organ recovery was less than 10%. Conclusion During the first week after listing for patients with ACLF-3, earlier LT in general is favored over waiting for an optimal quality donor organ or for recovery of organ failures, with the understanding that the analysis is limited to consideration of only these 3 variables. Lay summary In the setting of grade 3 acute-on-chronic liver failure (ACLF-3), questions remain regarding the timing of transplantation in terms of whether to proceed with liver transplantation with a marginal donor organ or to wait for an optimal liver, and whether to transplant a patient with ACLF-3 or wait until improvement to ACLF-2. In this study, we used a Markov decision process model to demonstrate that earlier transplantation of patients listed with ACLF-3 maximizes overall survival, as opposed to waiting for an optimal donor organ or for improvement in the number of organ failures.
Collapse
Affiliation(s)
- Suyanpeng Zhang
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Cynthia L Gong
- Fetal & Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Jessica Pham
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Jonel Trebicka
- Medical Department I, Frankfurt University Hospital, Germany.,European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
| | - Christophe Duvoux
- Medical Liver Transplant Unit-Liver Department, Henri Mondor Hospital AP-HP, Paris Est University, Créteil, France
| | - Andrew S Klein
- Department of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tiffany Wu
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
| | - Vinay Sundaram
- Karsh Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
7
|
Resch T, Hackl H, Esser H, Günther J, Schwelberger H, Ritschl PV, Ebner S, Maglione M, Mellitzer V, Biebl M, Öllinger R, Zoller H, Schneeberger S, Kotsch K. Expression of MICA in Zero Hour Biopsies Predicts Graft Survival After Liver Transplantation. Front Immunol 2021; 12:606146. [PMID: 34354697 PMCID: PMC8329650 DOI: 10.3389/fimmu.2021.606146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/30/2021] [Indexed: 01/14/2023] Open
Abstract
In search for novel biomarkers to assess graft quality, we investigated whether defined candidate genes are predictive for outcome after liver transplantation (LT). Zero-hour liver biopsies were obtained from 88 livers. Gene expression of selected candidate markers was analyzed and correlated with clinical parameters as well as short and long-term outcomes post LT. Whereas both, the calculated Eurotransplant Donor-Risk-Index and the donor body mass index, had either a poor or no predictive value concerning serum levels indicative for liver function (ALT, AST, GGT, bilirubin) after 6 months, chronological donor age was weakly predictive for serum bilirubin (AUC=0.67). In contrast, the major histcompatibility complex class I related chain A (MICA) mRNA expression demonstrated a high predictive value for serum liver function parameters revealing an inverse correlation (e.g. for ALT: 3 months p=0.0332; 6 months p=0.007, 12 months 0.0256, 24 months p=0.0098, 36 months, p=0.0153) and proved significant also in a multivariate regression model. Importantly, high expression of MICA mRNA revealed to be associated with prolonged graft survival (p=0.024; log rank test) after 10 years of observation, whereas low expression was associated with the occurrence of death in patients with transplant related mortality (p=0.031). Given the observed correlation with short and long-term graft function, we suggest MICA as a biomarker for pre-transplant graft evaluation.
Collapse
Affiliation(s)
- Thomas Resch
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hubert Hackl
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannah Esser
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Günther
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hubert Schwelberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Susanne Ebner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Vanessa Mellitzer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Biebl
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Heinz Zoller
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Katja Kotsch
- Department of General- and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
8
|
Lozanovski VJ, Probst P, Arefidoust A, Ramouz A, Aminizadeh E, Nikdad M, Khajeh E, Ghamarnejad O, Shafiei S, Ali-Hasan-Al-Saegh S, Seide SE, Kalkum E, Nickkholgh A, Czigany Z, Lurje G, Mieth M, Mehrabi A. Prognostic role of the Donor Risk Index, the Eurotransplant Donor Risk Index, and the Balance of Risk score on graft loss after liver transplantation. Transpl Int 2021; 34:778-800. [PMID: 33728724 DOI: 10.1111/tri.13861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
This study aimed to identify cutoff values for donor risk index (DRI), Eurotransplant (ET)-DRI, and balance of risk (BAR) scores that predict the risk of liver graft loss. MEDLINE and Web of Science databases were searched systematically and unrestrictedly. Graft loss odds ratios and 95% confidence intervals were assessed by meta-analyses using Mantel-Haenszel tests with a random-effects model. Cutoff values for predicting graft loss at 3 months, 1 year, and 3 years were analyzed for each of the scores. Measures of calibration and discrimination used in studies validating the DRI and the ET-DRI were summarized. DRI ≥ 1.4 (six studies, n = 35 580 patients) and ET-DRI ≥ 1.4 (four studies, n = 11 666 patients) were associated with the highest risk of graft loss at all time points. BAR > 18 was associated with the highest risk of 3-month and 1-year graft loss (n = 6499 patients). A DRI cutoff of 1.8 and an ET-DRI cutoff of 1.7 were estimated using a summary receiver operator characteristic curve, but the sensitivity and specificity of these cutoff values were low. A DRI and ET-DRI score ≥ 1.4 and a BAR score > 18 have a negative influence on graft survival, but these cutoff values are not well suited for predicting graft loss.
Collapse
Affiliation(s)
- Vladimir J Lozanovski
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Heidelberg, Germany
| | - Alireza Arefidoust
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ehsan Aminizadeh
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mohammadsadegh Nikdad
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Saeed Shafiei
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja E Seide
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Eva Kalkum
- The Study Center of the German Surgical Society (SDGC), University Hospital Heidelberg, Heidelberg, Germany
| | - Arash Nickkholgh
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Georg Lurje
- Department of Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Mieth
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Liver Cancer Center Heidelberg (LCCH), University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
9
|
Kwong AJ, Goel A, Mannalithara A, Kim WR. Improved posttransplant mortality after share 35 for liver transplantation. Hepatology 2018; 67:273-281. [PMID: 28586179 PMCID: PMC5756050 DOI: 10.1002/hep.29301] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED The Share 35 policy was implemented in June 2013 to improve equity in access to liver transplantation (LT) between patients with fulminant liver failure and those with cirrhosis and severe hepatic decompensation. The aim of this study was to assess post-LT outcomes after Share 35. Relevant donor, procurement, and recipient data were extracted from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. All adult deceased donor LTs from January 1, 2010, to March 31, 2016, were included in the analysis. One-year patient survival before and after Share 35 was assessed by multivariable Cox proportional hazards analysis, with adjustment for variables known to affect graft survival. Of 34,975 adult LT recipients, 16,472 (47.1%) were transplanted after the implementation of Share 35, of whom 4,599 (27.9%) had a Model for End-Stage Liver Disease (MELD) score ≥35. One-year patient survival improved from 83.9% to 88.4% after Share 35 (P < 0.01) for patients with MELD ≥35. There was no significant impact on survival of patients with MELD <35 (P = 0.69). Quality of donor organs, as measured by a donor risk index without the regional share component, improved for patients with MELD ≥35 (P < 0.01) and worsened for patients with lower MELD (P < 0.01). In multivariable Cox regression analysis, Share 35 was associated with improved 1-year patient survival (hazard ratio, 0.69; 95% confidence interval, 0.60-0.80) in recipients with MELD ≥35. CONCLUSION Share 35 has had a positive impact on survival after transplantation in patients with MELD ≥35, without a reciprocal detriment in patients with lower acuity; this was in part a result of more favorable donor-recipient matching. (Hepatology 2018;67:273-281).
Collapse
Affiliation(s)
- Allison J. Kwong
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, United States
| | - Aparna Goel
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, United States
| | - Ajitha Mannalithara
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, United States
| | - W. Ray Kim
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, United States
| |
Collapse
|
10
|
Campos-Varela I, Dodge JL, Stock PG, Terrault NA. Key donor factors associated with graft loss among liver transplant recipients with human immunodeficiency virus. Clin Transplant 2016; 30:1140-5. [PMID: 27411037 DOI: 10.1111/ctr.12800] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected liver transplant (LT) recipients have higher risk of graft loss than HIV-uninfected recipients. As the original donor risk index excluded HIV-positive patients, donor factors associated with graft loss in HIV-positive recipients are unknown. METHODS Identifying all HIV-positive patients in the Scientific Registry of Transplant Recipients, supplemented by all HIV-infected patients in the solid organ transplantation in HIV: Multi-Site Study (HIV-TR), we evaluated donor factors associated with graft loss among HIV-positive recipients transplanted between March 2002 and August 2012. RESULTS A total of 249 HIV-positive LT recipients were followed for median 2.4 (interquartile range [IQR]: 0.8-4.9) years. In univariate analysis, donor diabetes (HR=2.09; P=.002) and donor hypertension (HR=1.43; P=.048) were significantly associated with graft loss, and African-American (AA) recipient:non-AA donor race mismatch (HR=1.60; P=.07), other cause of donor death compared to trauma (HR=2.02; P=.09), and donor age 30 years or older (HR=1.53; P=.05) were of borderline significance. In multivariate analysis, donor diabetes (HR=2.12; 95% CI: 1.33-3.38; P=.002) was the only significant predictor of graft loss. CONCLUSION In HIV-positive LT recipients, risk of graft loss is strongly influenced by donor diabetes. This information may be useful to transplant physicians seeking to optimize overall graft survival in their HIV-positive LT recipients.
Collapse
Affiliation(s)
- Isabel Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID), Santiago de Compostela, Spain.,Department of Internal Medicine, Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jennifer L Dodge
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Peter G Stock
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Norah A Terrault
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA. .,Department of Surgery, University of California-San Francisco, San Francisco, CA, USA.
| |
Collapse
|
11
|
Jesudian A, Desale S, Julia J, Landry E, Maxwell C, Kallakury B, Laurin J, Shetty K. Donor Factors Including Donor Risk Index Predict Fibrosis Progression, Allograft Loss, and Patient Survival following Liver Transplantation for Hepatitis C Virus. J Clin Exp Hepatol 2016; 6:109-14. [PMID: 27493458 PMCID: PMC4963323 DOI: 10.1016/j.jceh.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/26/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The utilization of liver transplantation (LT) is limited by the availability of suitable organs. This study aimed to assess the impact of the donor risk index (DRI) and other donor characteristics on fibrosis progression, graft, and patient survival in hepatitis C virus (HCV)-infected LT recipients. METHODS HCV-infected LT recipients who had at least 2 post-LT protocol liver biopsy specimens available were included. Hazard ratio for bivariate analysis was computed using Cox proportional hazard regression analysis. RESULTS Of 312 recipients, 26.6% died over a median follow-up of 58.5 months (95% CI: 46.5-67.3). Fourteen patients underwent re-transplantation. Mean time to graft failure was 84.3 months, median follow-up: 59 months, 95% CI (48.2, 68.3). DRI >1.5 was significantly associated with patient and graft survival (P = 0.04). Of the subset of 104 individuals who underwent histological analysis, 67.3% progressed to ≥F2. On multivariate analysis, significant donor-specific predictors of fibrosis progression were: donor age >50 years and DRI >1.7. CONCLUSIONS (1) Fibrosis progression in HCV-infected LT recipients is strongly associated with donor characteristics, specifically donor age and DRI. (2) DRI, an objective measure of donor quality, appears to correlate both with rate of histological progression and overall patient/graft survival.
Collapse
Key Words
- AA, African-American
- CDA, corrected donor age
- CI, confidence interval
- CIT, cold ischemic time
- DCD, donation after cardiac death
- DM, diabetes mellitus
- DRI, donor risk index
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- HL, hyperlipidemia
- HTN, hypertension
- Hepatitis C
- LBx, liver biopsy
- LT, liver transplantation
- MMF, mycophenolate mofetil
- OPTN, Organ Procurement and Transplantation Network
- OTTR, organ transplant tracking record
- REDCap, Research Database Capture
- TAC, tacrolimus
- UNOS, United Network for Organ Sharing
- donor risk index
- liver transplantation
Collapse
Affiliation(s)
- Arun Jesudian
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, United States
| | | | | | | | | | - Bhaskar Kallakury
- Department of Pathology, MedStar Georgetown University Hospital, United States
| | - Jacqueline Laurin
- Division of Gastroenterology and Hepatology, Johns Hopkins University, United States
| | - Kirti Shetty
- Division of Gastroenterology and Hepatology, Johns Hopkins University, United States,Address for correspondence: Kirti Shetty, Sibley Medical Building, 5215 Loughboro Road, #320, Washington, DC 20016, United States. Tel.: +1 202 660 5584; fax: +1 202 660 7359.Sibley Medical Building, 5215 Loughboro Road, #320WashingtonDC20016United States
| |
Collapse
|
12
|
Schukfeh N, Paul A, Gallinat A, Hoyer DP, Treckmann JW, Minor T, Sotiropoulos GC, Metzelder ML, Schulze M. Using pediatric liver grafts (≤ 6 yr) for adult recipients: A considerable option? Pediatr Transplant 2015; 19:875-9. [PMID: 26346176 DOI: 10.1111/petr.12589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
Abstract
In LT, the common policy is to allocate pediatric liver grafts to pediatric recipients. Pediatric organs are also offered to adults if there is no pediatric recipient. However, they are rarely accepted for adult recipients. So far, there is no information available reporting outcome of LT in adult recipients using pediatric livers from donors ≤ 6 yr. In this study, we included nine adult recipients (seven females and two males) who received grafts from children ≤ 6 yr from January 2008 to December 2013. We evaluated the graft quality, the GBWR and analyzed the recipients' perioperative course. Laboratory samples and graft perfusion were analyzed. Nine adults with a median age of 49 yr (range: 25-65) and a median weight of 60 kg (range: 48-64) underwent LT with a pediatric donor graft. Median donor age was five yr (range: 3-6). Median GBWR was 1.02 (range: 0.86-1.45). After a median follow-up of 3.9 yr (range: 11 months-6.6 yr), patient survival was 100%; graft survival was 89%. One patient needed re-transplantation on the second postoperative day due to PNF. Eight recipients were discharged from the ICU after 2-9 days with a regular graft function. Doppler scans revealed regular flow patterns at any time. Only if denied for pediatric recipients, the use of pediatric livers from donors ≤ 6 yr for adult recipients is a considerable option.
Collapse
Affiliation(s)
- Nagoud Schukfeh
- Division of Pediatric Surgery, Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Andreas Paul
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Anja Gallinat
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Dieter P Hoyer
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Jürgen W Treckmann
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Thomas Minor
- Surgical Research Division, University Hospital Bonn, Bonn, Germany
| | - Georgios C Sotiropoulos
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Martin L Metzelder
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Maren Schulze
- Department of General-Visceral and Transplant Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
13
|
Asrani SK, Kim WR, Edwards EB, Larson J, Thabut G, Kremers WK, Therneau TM, Heimbach J. Impact of the center on graft failure after liver transplantation. Liver Transpl 2013; 19:957-64. [PMID: 23784730 PMCID: PMC4130473 DOI: 10.1002/lt.23685] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 05/19/2013] [Indexed: 12/31/2022]
Abstract
The hospital at which liver transplantation (LT) is performed has a substantial impact on post-LT outcomes. Center-specific outcome data are closely monitored not only by the centers themselves but also by patients and government regulatory agencies. However, the true magnitude of this center effect, apart from the effects of the region and donor service area (DSA) as well as recipient and donor determinants of graft survival, has not been examined. We analyzed data submitted to the Organ Procurement and Transplantation Network for all adult (age ≥ 18 years) primary LT recipients (2005-2008). Using a mixed effects, proportional hazards regression analysis, we modeled graft failure within 1 year after LT on the basis of center (de-identified), region, DSA, and donor and recipient characteristics. At 115 unique centers, 14,654 recipients underwent transplantation. Rates of graft loss within a year varied from 5.9% for the lowest quartile of centers to 20.2% for the highest quartile. Gauged by a comparison of the 75th and 25th percentiles of the data, the magnitude of the center effect on graft survival (1.49-fold change) was similar to that of the recipient Model for End-Stage Liver Disease (MELD) score (1.47) and the donor risk index (DRI; 1.45). The center effect was similar across the DRI and MELD score quartiles and was not associated with a center's annual LT volume. After stratification by region and DSA, the magnitude of the center effect, though decreased, remained significant and substantial (1.30-fold interquartile difference). In conclusion, the LT center is a significant predictor of graft failure that is independent of region and DSA as well as donor and recipient characteristics.
Collapse
Affiliation(s)
- Sumeet K Asrani
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota,Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - W. Ray Kim
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota,William J. von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota,Corresponding Author W Ray Kim, 200 First Street SW, Rochester, Minnesota 55905, fax: 507-538-3974, telephone: 507-538-0254
| | - Erick B. Edwards
- Assistant Director of Research, United Network for Organ Sharing
| | - Joseph Larson
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Gabriel Thabut
- Service de pneumologie B et transplantation pulmonaire, Hôpital Bichat, Paris, France,Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Terry M Therneau
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Julie Heimbach
- William J. von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota,Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|
14
|
Volk ML, Roney M, Merion RM. Systematic bias in surgeons' predictions of the donor-specific risk of liver transplant graft failure. Liver Transpl 2013; 19:987-90. [PMID: 23784716 PMCID: PMC3775958 DOI: 10.1002/lt.23683] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/21/2013] [Indexed: 12/23/2022]
Abstract
The decision to accept or decline a liver allograft for a patient on the transplant waiting list is complex. We hypothesized that surgeons are not accurate at predicting donor-specific risks. Surgeon members of the American Society of Transplant Surgeons were invited to complete a survey in which they predicted the 3-year risk of graft failure for a 53-year-old man with alcoholic cirrhosis and a Model for End-Stage Liver Disease score of 21 with a liver from (1) a 30-year-old local donor with traumatic brain death or (2) a 64-year-old regional donor with brain death from a stroke. Complete responses were obtained from 201 surgeons, whose self-reported case volume represents the majority of liver transplants in the United States. The surgeon-predicted 3-year risk of graft failure varied widely (more than 10-fold). In scenario 1, 90% of the respondents provided lower estimates of the graft failure risk than the literature-derived estimate of 21% (P < 0.001). In scenario 2, 96% of the responses were lower than the literature-derived estimate of 40% (P < 0.001). In conclusion, transplant surgeons vary widely in their predictions of the donor-specific risk of graft failure, and they demonstrate a systematic bias toward inaccurately low estimates of graft failure, particularly for higher risk organs.
Collapse
Affiliation(s)
- Michael L. Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System
| | - Meghan Roney
- Center for Bioethics and Social Sciences in Medicine, University of Michigan
| | - Robert M. Merion
- Division of Transplantation Surgery, University of Michigan Health System
| |
Collapse
|
15
|
Abstract
Not only is there a limited supply of organs for liver transplantation, but the quality of the available organs is not uniform. Risk factors such as donor age and cause of death are known to predict graft failure, but their impact on the recipient's quality of life (QOL) has not been reported. We sent a QOL survey to 299 adults at our institution who had received a liver transplant 1 to 7 years before the study. For the 171 patients (57%) who completed the Medical Outcomes Study Short Form 36 (SF-36), the mean Physical Composite Score (PCS) and the mean Mental Composite Score (MCS) were 61 and 66, respectively; the highest scores were for the Social Functioning subscale, and the lowest scores were for the Role Functioning/Physical and Energy/Fatigue subscales. The mean donor risk index (DRI) of the organs that the subjects received was 1.4 (range = 0.8-2.4). There was no correlation between the SF-36 scores and the DRI [there were changes of -4.8 and -2.8 in the PCS and MCS per unit increase in the DRI (P = 0.4 and 0.6, respectively)], even though we controlled for potential confounders such as age, sex, hospitalization before transplantation, the Model for End-Stage Liver Disease score at transplantation, years since transplantation, previous transplantation, and the Charlson comorbidity index. In conclusion, we found no association between organ quality and QOL after liver transplantation. If this finding is confirmed in prospective, multicenter studies, it will be useful in counseling patients about the decision to accept or not accept high-risk organ offers.
Collapse
Affiliation(s)
- Michael L. Volk
- Division of Gastroenterology and Hepatology, University of Michigan
| | | |
Collapse
|
16
|
Abstract
BACKGROUND A growth in the utilization of high-risk allografts is reflective of a critical national shortage and the increasing waiting list mortality. Using risk-adjusted models, the aim of the present study was to determine whether a volume-outcome relationship existed among liver transplants at high risk for allograft failure. METHODS From 2002 to 2008, the Scientific Registry of Transplant Recipients (SRTR) database for all adult deceased donor liver transplants (n = 31 587) was queried. Transplant centres (n = 102) were categorized by volume into tertiles: low (LVC; 31 cases/year), medium (MVC: 64 cases/year) and high (HVC: 102 cases/year). Donor risk comparison groups were stratified by quartiles of the Donor Risk Index (DRI) spectrum: low risk (DRI ≤ 1.63), moderate risk (1.64 > DRI > 1.90), high risk (1.91 > DRI > 2.26) and very high risk (DRI ≥ 2.27). RESULTS HVC more frequently used higher-risk livers (median DRI: LVC: 1.82, MVC: 1.90, HVC: 1.97; P < 0.0001) and achieved better risk adjusted allograft survival outcomes compared with LVC (HR: 0.90, 95%CI: 0.85-0.95). For high and very high risk groups, transplantation at a HVC did contribute to improved graft survival [high risk: hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.76-0.96; Very High Risk: HR: 0.88, 95%CI: 0.78-0.99]. CONCLUSION While DRI remains an important aspect of allograft survival prediction models, liver transplantation at a HVC appears to result in improved allograft survival with high and very high risk DRI organs compared with LVC.
Collapse
Affiliation(s)
- Deepak K Ozhathil
- Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Salvalaggio PR, Dzebisashvili N, MacLeod KE, Lentine KL, Gheorghian A, Schnitzler MA, Hohmann S, Segev DL, Gentry SE, Axelrod DA. The interaction among donor characteristics, severity of liver disease, and the cost of liver transplantation. Liver Transpl 2011; 17:233-42. [PMID: 21384505 PMCID: PMC4447593 DOI: 10.1002/lt.22230] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Accurate assessment of the impact of donor quality on liver transplant (LT) costs has been limited by the lack of a large, multicenter study of detailed clinical and economic data. A novel, retrospective database linking information from the University HealthSystem Consortium and the Organ Procurement and Transplantation Network registry was analyzed using multivariate regression to determine the relationship between donor quality (assessed through the Donor Risk Index [DRI]), recipient illness severity, and total inpatient costs (transplant and all readmissions) for 1 year following LT. Cost data were available for 9059 LT recipients. Increasing MELD score, higher DRI, simultaneous liver-kidney transplant, female sex, and prior liver transplant were associated with increasing cost of LT (P < 0.05). MELD and DRI interact to synergistically increase the cost of LT (P < 0.05). Donors in the highest DRI quartile added close to $12,000 to the cost of transplantation and nearly $22,000 to posttransplant costs in comparison to the lowest risk donors. Among the individual components of the DRI, donation after cardiac death (increased costs by $20,769 versus brain dead donors) had the greatest impact on transplant costs. Overall, 1-year costs were increased in older donors, minority donors, nationally shared organs, and those with cold ischemic times of 7-13 hours (P < 0.05 for all). In conclusion, donor quality, as measured by the DRI, is an independent predictor of LT costs in the perioperative and postoperative periods. Centers in highly competitive regions that perform transplantation on higher MELD patients with high DRI livers may be particularly affected by the synergistic impact of these factors.
Collapse
Affiliation(s)
| | - Nino Dzebisashvili
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Kara E. MacLeod
- Department of Surgery, University of Washington, Seattle, WA, Surgical Outcomes Research Center, University of Washington, Seattle, WA
| | - Krista L. Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Adrian Gheorghian
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Mark A. Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Sommer E. Gentry
- Department of Mathematics, United States Naval Academy, Baltimore, MD
| | - David A. Axelrod
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH
| |
Collapse
|
18
|
Abstract
Some studies have found that donor-recipient gender mismatch predicts posttransplant outcomes but whether this is independent of donor quality is unknown. To evaluate the association between gender mismatch and graft loss, 11 508 females (F) and 16 714 males (M) who underwent liver transplant from March 1, 2002 to December 31, 2007 were studied. Of 11 donor characteristics, clinically relevant differences between F and M donors were median age (47 vs. 39 years), height (165 vs. 178 cm) and proportion dying of stroke (59 vs. 35%) (p < 0.001 for all). The donor risk index was significantly lower for F than M donors (1.3 vs. 1.6, p < 0.001). Recipients of gender-mismatched grafts had an 11% higher risk of graft loss (p < 0.001). Compared to M→M donor-recipient-matched transplants in univariable analysis, F→M mismatch was associated with a 17% increased risk of graft loss (95% CI = 1.11-1.24, p < 0.001), whereas M→F mismatch was not (HR = 1.02; 95% CI = 0.96-1.09; p = 0.46). However, adjustment for significant recipient and donor factors eliminated the association between F→M mismatch and graft loss (HR = 0.95; 95% CI = 0.89-1.02; p = 0.18). In conclusion, donor quality differs significantly between female and male donors-female donors are older, shorter and die more frequently of stroke-and gender differences in donor quality, rather than gender mismatch are predictive of graft loss.
Collapse
Affiliation(s)
- Jennifer C. Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA
| | - Sandy Feng
- Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA
| | - John P. Roberts
- Department of Surgery, Division of Transplant Surgery, University of California San Francisco, San Francisco, CA
| | - Norah A. Terrault
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA
| |
Collapse
|
19
|
ASRANI SUMEETK, LIM YOUNGSUK, THERNEAU TERRYM, PEDERSEN RACHELA, HEIMBACH JULIE, KIM WRAY. Donor race does not predict graft failure after liver transplantation. Gastroenterology 2010; 138:2341-7. [PMID: 20176028 PMCID: PMC2907133 DOI: 10.1053/j.gastro.2010.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 01/26/2010] [Accepted: 02/09/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Donor race has been proposed to predict graft failure after liver transplantation. We evaluated the extent to which the center where the transplantation surgery was performed and other potential confounding factors might account for the observed association between donor race and graft failure. METHODS We analyzed data from the Organ Procurement and Transplantation Network (January 2003-December 2005) for adult patients undergoing primary liver transplantation in the United States. We examined the association between graft failure and the donor races of African American (AA), Caucasian, Asian/Pacific Islander (API), or those classified as other. RESULTS Of 10,874 livers that were donated for transplantation, 7631 came from Caucasians, 1579 from AAs, 243 from APIs, and 1421 from others. After 36 months of follow-up evaluation, 2687 grafts failed. Without any adjustments, AA donors (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.00-1.24), API donors (HR, 1.41; 95% CI, 1.12-1.77), and other donors (HR, 1.16; 95% CI, 1.04-1.29) were associated with graft failure. After stratification by center and adjustments for age, height, and hepatitis B core antibody status of donors as well as serum creatinine and hepatitis C status of recipients, donor race was no longer statistically significant for AA (HR, 1.06; 95% CI, 0.95-1.20) and API (HR, 1.15; 95% CI, 0.89-1.49) donors. However, livers donated from members of other race still had an increased risk of graft failure (HR, 1.19; 95% CI, 1.05-1.35), although the effect was not uniform across donor-recipient pairs. CONCLUSIONS Donor race is not a uniform predictor of graft failure and should not be construed as an indicator of donor quality.
Collapse
Affiliation(s)
- SUMEET K. ASRANI
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - TERRY M. THERNEAU
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - RACHEL A. PEDERSEN
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - JULIE HEIMBACH
- William J. von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - W. RAY KIM
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota,William J. von Liebig Transplant Center, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|