Contribution of Marginal Donors to Liver Transplantation for Hepatitis C Virus Infection

• Published in: Transplantation proceedings Vol. 39; no. 7; pp. 2297 - 2299
• Main Authors: Briceño, J, Ciria, R, Pleguezuelo, M, Naranjo, Á, Sánchez-Hidalgo, J, Ruiz-Rabelo, J, López-Cillero, P, Luque, A, de la Mata, M, Rufián, S
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2007; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis C - surgery; Human viral diseases; Humans; Infectious diseases; Liver Transplantation - mortality; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Patient Selection; Recurrence; Reoperation - statistics & numerical data; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Tissue Donors - statistics & numerical data; Tissue, organ and graft immunology; Viral diseases; Viral hepatitis; Suboptimal donor; Digestive system; Hepatic disease; Homotransplantation; Infection; Medicine; Treatment; Surgery; Viral disease; Digestive diseases; Graft; Viral hepatitis C; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.07.069

Abstract The use of marginal liver donors can affect the outcomes of liver transplantation in patients with hepatitis C virus (HCV) infection. There are no firm conclusions about which donor criteria are important for allocation of high-risk grafts to recipients with HCV cirrhosis. We performed 120 consecutive liver transplantations for HCV infection between 1995 and 2005. Marginal donor criteria were considered to be: age >70 years, macrovesicular steatosis >30%, moderate-to-severe liver preservation injury, high inotropic drug dose (dopamine >15 μg/kg/min; epinephrine, norepinephrine, or dobutamine at any doses), peak serum sodium >155 mEq/L, any hypotensive episode <60 mm Hg and >1 hour, cold ischemia time >12 hours, ICU hospitalization >4 days, bilirubin >2 mg/dL, AST and/or ALT >200 UI/dL. Graft survival with donors showing these marginal criteria was compared with optimal donors using Kaplan-Meier analysis and the log-rank test. Independent predictors of survival were computed with the Cox proportional hazards model. Fifty-six grafts (46%) were lost during follow-up irrespective of the Model for End-Stage Liver Disease (MELD) scores of the recipients in each category. Upon univariate analysis, grafts with moderate-to-severe steatosis ( P = .012), those with severe liver preservation injury ( P = .007) and prolonged cold ischemia time ( P = .0001) showed a dismal prognosis at 1, 3, and 5 years. Upon multivariate analysis, fat content ( P = .0076; OR = 4.2) and cold ischemia time >12 hours ( P = .034; OR = 7.001) were independent predictors of graft survival. Among HCV recipients, marginal liver donors worked similar to those from “good” donors, except for those with fatty livers >30%, especially when combined with a prolonged cold ischemia time.