Impact of Expanded-Criteria Donors on Patient Survival After Heart, Lung, Liver and Combined Organ Transplantation

Abstract

BackgroundThe age and comorbidities of brain-dead donors have increased throughout the past decade. The use of expanded-criteria donors (ECDs) has become a common clinical practice. The objective of the present study was to compare outcomes of patients who underwent heart, lung, liver, and combined organ transplantations from expanded- versus standard-criteria donors (SCDs). MethodsWe studied 867 adult patients who received deceased-donor organs in 6 Québec centers from 2003 to 2009. Patient survival was analyzed with the use of univariate methods with respect to the effect of donor and recipient characteristics. ECDs were defined according to United Network for Organ Sharing criteria: age >60 years (or 50–59 years with 2 associated risk factors), and history of cerebrovascular accident, hypertension, or elevated serum creatinine. ResultsAmong the 664 donors, 438 were SCDs (66%) and 226 ECDs (34%). Two-year recipient survival averaged 78 ± 2% versus 77 ± 3% in SCD and ECD groups, respectively, following liver; 78 ± 3% versus 74 ± 10% after lung 87 ± 3% versus 72 ± 12% following heart, and 75 ± 9% and 67 ± 19% after combined organ transplantation (P > .05 for all organs). ConclusionThe current definition of SCD and ECD had no effect on patient survival after lung or liver transplantation. There was a trend toward decreased patient survival among heart and combined organ transplant recipients of ECDs. Specific donor critieria should be defined to quantify donor risk factors for each extrarenal organ.