Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival

A. Joseph Tector, Richard Mangus, Paul Chestovich, Rodrigo Vianna, Jonathan A. Fridell, Martin L. Milgrom, Carrie Sanders, Paul Y. Kwo

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

INTRODUCTION: The use of extended criteria donors (ECDs) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors. This study compares the graft/patient survival from standard (SD) and ECD for our transplant population between 2001 and 2005. METHODS: Records of all adult liver transplant recipients over 4 years were reviewed (n = 571). ECD criteria included: age >59 years, BMI >34.9, maximum AST/ALT >500, maximum bilirubin >2.0, peak serum sodium >170, HBV/HCV/HTLV reactive, donation after cardiac death, cold ischemia time >12 hours, ICU stay >5 days, 3 or more pressors simultaneously, extensive alcohol abuse, cancer history (nonskin), active meningitis/bacteremia, or significant donor liver trauma. Outcomes included graft and patient survival at 90 days, 1 year, and 2 years. RESULTS: Sixty-eight percent of recipients (n = 388) received ECD livers. Primary factors accounting for ECD-liver status included: elevated liver function tests (20%), hypernatremia (12.6%), and extensive alcohol abuse (11.4%). Graft survival was (SD, ECD): 90-day 91%, 88%; 1-year 84%, 80%; 2-year 78%, 77%; patient survival was: 90-day 93%, 90%; 1-year 87%, 82%; 2-year 83%, 79%. Kaplan-Meier survival analysis failed to demonstrate an overall difference in graft or patient survival at any time point. Only donor age >60 years was associated with decreased graft and patient survival. CONCLUSIONS: Liver grafts from ECD can be used to dramatically reduce wait list time with outcomes comparable to those for SD without resorting to living donor liver transplantation.

Original languageEnglish
Pages (from-to)439-448
Number of pages10
JournalAnnals of Surgery
Volume244
Issue number3
DOIs
StatePublished - Sep 2006

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Liver Transplantation
Tissue Donors
Survival
Liver
Graft Survival
Living Donors
Transplants
Alcoholism
Hypernatremia
Cold Ischemia
Liver Function Tests
Kaplan-Meier Estimate
Survival Analysis
Bacteremia
Meningitis
Bilirubin
Sodium
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. / Tector, A. Joseph; Mangus, Richard; Chestovich, Paul; Vianna, Rodrigo; Fridell, Jonathan A.; Milgrom, Martin L.; Sanders, Carrie; Kwo, Paul Y.

In: Annals of Surgery, Vol. 244, No. 3, 09.2006, p. 439-448.

Research output: Contribution to journalArticle

Tector, A. Joseph ; Mangus, Richard ; Chestovich, Paul ; Vianna, Rodrigo ; Fridell, Jonathan A. ; Milgrom, Martin L. ; Sanders, Carrie ; Kwo, Paul Y. / Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. In: Annals of Surgery. 2006 ; Vol. 244, No. 3. pp. 439-448.
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title = "Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival",
abstract = "INTRODUCTION: The use of extended criteria donors (ECDs) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors. This study compares the graft/patient survival from standard (SD) and ECD for our transplant population between 2001 and 2005. METHODS: Records of all adult liver transplant recipients over 4 years were reviewed (n = 571). ECD criteria included: age >59 years, BMI >34.9, maximum AST/ALT >500, maximum bilirubin >2.0, peak serum sodium >170, HBV/HCV/HTLV reactive, donation after cardiac death, cold ischemia time >12 hours, ICU stay >5 days, 3 or more pressors simultaneously, extensive alcohol abuse, cancer history (nonskin), active meningitis/bacteremia, or significant donor liver trauma. Outcomes included graft and patient survival at 90 days, 1 year, and 2 years. RESULTS: Sixty-eight percent of recipients (n = 388) received ECD livers. Primary factors accounting for ECD-liver status included: elevated liver function tests (20{\%}), hypernatremia (12.6{\%}), and extensive alcohol abuse (11.4{\%}). Graft survival was (SD, ECD): 90-day 91{\%}, 88{\%}; 1-year 84{\%}, 80{\%}; 2-year 78{\%}, 77{\%}; patient survival was: 90-day 93{\%}, 90{\%}; 1-year 87{\%}, 82{\%}; 2-year 83{\%}, 79{\%}. Kaplan-Meier survival analysis failed to demonstrate an overall difference in graft or patient survival at any time point. Only donor age >60 years was associated with decreased graft and patient survival. CONCLUSIONS: Liver grafts from ECD can be used to dramatically reduce wait list time with outcomes comparable to those for SD without resorting to living donor liver transplantation.",
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T1 - Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival

AU - Tector, A. Joseph

AU - Mangus, Richard

AU - Chestovich, Paul

AU - Vianna, Rodrigo

AU - Fridell, Jonathan A.

AU - Milgrom, Martin L.

AU - Sanders, Carrie

AU - Kwo, Paul Y.

PY - 2006/9

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N2 - INTRODUCTION: The use of extended criteria donors (ECDs) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors. This study compares the graft/patient survival from standard (SD) and ECD for our transplant population between 2001 and 2005. METHODS: Records of all adult liver transplant recipients over 4 years were reviewed (n = 571). ECD criteria included: age >59 years, BMI >34.9, maximum AST/ALT >500, maximum bilirubin >2.0, peak serum sodium >170, HBV/HCV/HTLV reactive, donation after cardiac death, cold ischemia time >12 hours, ICU stay >5 days, 3 or more pressors simultaneously, extensive alcohol abuse, cancer history (nonskin), active meningitis/bacteremia, or significant donor liver trauma. Outcomes included graft and patient survival at 90 days, 1 year, and 2 years. RESULTS: Sixty-eight percent of recipients (n = 388) received ECD livers. Primary factors accounting for ECD-liver status included: elevated liver function tests (20%), hypernatremia (12.6%), and extensive alcohol abuse (11.4%). Graft survival was (SD, ECD): 90-day 91%, 88%; 1-year 84%, 80%; 2-year 78%, 77%; patient survival was: 90-day 93%, 90%; 1-year 87%, 82%; 2-year 83%, 79%. Kaplan-Meier survival analysis failed to demonstrate an overall difference in graft or patient survival at any time point. Only donor age >60 years was associated with decreased graft and patient survival. CONCLUSIONS: Liver grafts from ECD can be used to dramatically reduce wait list time with outcomes comparable to those for SD without resorting to living donor liver transplantation.

AB - INTRODUCTION: The use of extended criteria donors (ECDs) could minimize shortage of suitable donor livers for transplantation. In 3 years, the aggressive use of ECD livers has reduced the wait list at our center from 257 to 30 patients with a median wait time of 18 days without using living donors. This study compares the graft/patient survival from standard (SD) and ECD for our transplant population between 2001 and 2005. METHODS: Records of all adult liver transplant recipients over 4 years were reviewed (n = 571). ECD criteria included: age >59 years, BMI >34.9, maximum AST/ALT >500, maximum bilirubin >2.0, peak serum sodium >170, HBV/HCV/HTLV reactive, donation after cardiac death, cold ischemia time >12 hours, ICU stay >5 days, 3 or more pressors simultaneously, extensive alcohol abuse, cancer history (nonskin), active meningitis/bacteremia, or significant donor liver trauma. Outcomes included graft and patient survival at 90 days, 1 year, and 2 years. RESULTS: Sixty-eight percent of recipients (n = 388) received ECD livers. Primary factors accounting for ECD-liver status included: elevated liver function tests (20%), hypernatremia (12.6%), and extensive alcohol abuse (11.4%). Graft survival was (SD, ECD): 90-day 91%, 88%; 1-year 84%, 80%; 2-year 78%, 77%; patient survival was: 90-day 93%, 90%; 1-year 87%, 82%; 2-year 83%, 79%. Kaplan-Meier survival analysis failed to demonstrate an overall difference in graft or patient survival at any time point. Only donor age >60 years was associated with decreased graft and patient survival. CONCLUSIONS: Liver grafts from ECD can be used to dramatically reduce wait list time with outcomes comparable to those for SD without resorting to living donor liver transplantation.

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