The Utility of Extended Criteria Donor Livers in High Acuity Liver Transplant Recipients

2021 ◽  
pp. 000313482110246
Author(s):  
Jacob Guorgui ◽  
Takahiro Ito ◽  
Stephanie Younan ◽  
Vatche G. Agopian ◽  
Joseph Dinorcia ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Potential Method ◽  
Donor Pool ◽  
Extended Criteria Donor ◽  
High Acuity ◽  
Donor Graft ◽  
Short And Long Term ◽  
End Stage ◽  
Liver Transplant Recipients

Background Although the use of extended criteria donor (ECD) liver allografts has gained momentum as a potential method by which to expand the donor pool, their use largely remains relegated to low acuity liver transplant (LT) recipients. Thus, we sought to examine whether such grafts also have utility in high acuity (Model for End-Stage Liver Disease [MELD] ≥ 35) recipients. Study Design Extended criteria donors were defined as donor age > 60 years, hepatitis C virus positive donor, split livers, livers with cold ischemia time > 12 h, donor after cardiac death livers, or having macrosteatosis > 30%. Outcomes were compared between standard liver (SL) and ECD grafts in recipients with MELD ≥ 35. Results Of 225 patients, 46 (20.4%) received an ECD liver and 179 (79.6%) received a SL. Extended criteria donor graft recipients had significantly higher levels of post-LT maximal transaminases and rate of early allograft dysfunction. Nonetheless, high acuity ECD graft recipients had similar short- and long-term patient survival compared to SL recipients, with 1-,3-, and 5-year survivals of 86.9%, 82.3%, 79.3% and 86.9%, 80.5%, and 75.4%, respectively ( P = .674). There were also no significant differences in graft survival or rejection-free survival between the 2 groups. Conclusion The lack of inferior patient/graft survival among high acuity ECD graft recipients suggests that ECD livers present a viable method by which to expand the donor pool for this group of patients.

Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival

1998 ◽  
Vol 47 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Rafat S. Rizk ◽  
John P. McVicar ◽  
Mary J. Emond ◽  
Charles A. Rohrmann ◽  
Kris V. Kowdley ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Endoscopic Management ◽  
Transplant Recipients ◽  
Biliary Strictures ◽  
Liver Transplant Recipients ◽  
Patient And Graft Survival

scholarly journals Making an equal system equitable: Proposing a sex-adjusted MELDNa score for liver transplantation allocation

2021 ◽  
Author(s):  
Julia M Sealock ◽  
Ioannis Ziogas ◽  
Zhiguo Zhao ◽  
Fei Ye ◽  
Sophoclis Alexopoulos ◽  
...  
Keyword(s):  
Sex Differences ◽  
Liver Disease ◽  
Liver Transplant ◽  
Medical Center ◽  
International Normalized Ratio ◽  
Liver Allocation ◽  
Sex Disparities ◽  
Adjusted Scores ◽  
End Stage ◽  
Liver Transplant Recipients

Background & Aims: Liver allocation is determined by the model for end-stage liver disease (MELD), a scoring system based on four laboratory measurements. During the MELD era, sex disparities in liver transplant have increased and there are no modifications to MELD based on sex. We use data from electronic health records (EHRs) to describe sex differences in MELD labs and propose a sex adjustment. Methods: We extracted lab values for creatinine, International Normalized Ratio of prothrombin rate, bilirubin, and sodium from EHRs at Vanderbilt University Medical Center (VUMC) and the All of Us Research Project to determine sex differences in lab traits. We calculated MELDNa scores within liver transplant recipients, non-transplanted liver disease cases, and non-liver disease controls separately. To account for sex differences in lab traits in MELDNa scoring, we created a sex-adjusted MELDNa map which outputs adjusted female scores mapped to male scores of equal liver disease severity. Using waitlist data from the Liver Simulated Allocation Modeling, we conducted simulations to determine if the sex-adjusted scores reduced sex disparities. Results: All component MELDNa lab values and calculated MELDNa scores yielded significant sex differences within VUMC (n=623,931) and All of Us (n=56,715) resulting in MELDNa scoring that disadvantaged females who, despite greater decompensation traits, had lower MELDNa scores. In simulations, the sex-adjusted MELDNa score modestly increased female transplantation rate and decreased overall death. Conclusions: Our results demonstrate pervasive sex differences in all labs used in MELDNa scoring and highlight the need and utility of a sex-adjustment to the MELDNa protocol.

Cholecystitis in Patients Undergoing Liver Transplantation: A Five-Year Analysis of Incidence, Causes, and Impact

2020 ◽  
Vol 86 (10) ◽  
pp. 1254-1259
Author(s):  
Danielle S. Graham ◽  
Takahiro Ito ◽  
Michelle Lu ◽  
Joseph Dinorcia ◽  
Vatche G. Agopian ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Patient Population ◽  
Patient Survival ◽  
Kaplan Meier ◽  
High Acuity ◽  
Transplant Candidates ◽  
Pathology Reports ◽  
End Stage ◽  
High Index Of Suspicion

There is a paucity of data on cholecystitis in liver transplant candidates (LTC), including the incidence of the cholecystitis and the associated outcomes in this patient population. As such, this study examines the incidence of and factors associated with cholecystitis in the high-acuity LTC population, as well as the association between cholecystitis and graft and patient survival. Liver transplant candidates undergoing orthotopic liver transplantation (OLT) at a large transplant center from January 1, 2012 to December 31, 2016 were included in the initial analysis. Surgical pathology reports were examined for the presence of cholecystitis. Univariate analyses were performed to determine the association between patient factors and cholecystitis. Kaplan-Meier analyses and multivariate Cox proportional hazard models were performed to examine the association between cholecystitis and graft and patient survival. Of the 405 patients in the final study population, 267 (65.9%) had no cholecystitis, 21 (5.2%) had acute cholecystitis, and 117 (28.9%) had chronic cholecystitis. The presence of cholecystitis was associated with preoperative WBC, sepsis within 10 days prior to transplant, location prior to transplant, and total length of stay. While this study revealed no association between cholecystitis and graft or patient survival, it also suggests that cholecystitis is under-recognized in high-model end-stage liver disease (MELD) OLT candidates. Therefore, a high index of suspicion for cholecystitis may be helpful in caring for this vulnerable patient population; however, further studies must be performed to determine the optimal management of cholecystitis in these patients.

scholarly journals Anti-HLA and Anti-MICA Antibodies in Liver Transplant Recipients: Effect on Long-Term Graft Survival

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Michał Ciszek ◽  
Bartosz Foroncewicz ◽  
Krzysztof Mucha ◽  
Dorota Żochowska ◽  
Bogna Ziarkiewicz-Wróblewska ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Graft Survival ◽  
Graft Rejection ◽  
Liver Graft ◽  
Negative Group ◽  
Transplant Recipients ◽  
Blood Samples ◽  
Positive Group ◽  
Liver Transplant Recipients

Objective. Presence of anti-HLA antibodies has a well-known impact on kidney grafts survival; however their role in liver transplantation has not been fully elucidated. We conducted a 7-year prospective study to show correlation between presence of anti-HLA and anti-MICA antibodies and liver graft survival.Methods. Blood samples from 123 liver transplant recipients were collected during patients routine visits. Time from transplantation to blood sample collection was different for each patient. Blood samples were tested for anti-HLA (separately class I and II) and MICA antibodies using Luminex assays.Results. There were 32 (26%) patients with positive anti-HLA and 37 (30%) with positive anti-MICA antibodies. Graft loss occurred in 7 cases (23%) in anti-HLA positive group compared to 20 (22%) in anti-HLA negative group (P=ns) and in 8 cases (22%) in anti-MICA positive group but 19 (23%) in anti-MICA negative group (P=ns). No correlations were detected between presence of antibodies and acute graft rejection (AGR). Presence of any antibodies (anti-HLA or anti-MICA antibodies) correlated with late graft rejection (P=0.04).Conclusion. Presence of anti-HLA or anti-MICA had no impact on long-term liver graft survival; however, detection of any antibodies was correlated with episodes of late graft rejection.

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