Abstract
Background: Not all extended donor criteria (EDC) have an equal impact on graft survival after liver transplant (LT). We designed this study to identify a combination of EDC that predicts graft failure in the MELD-score era. Methods: We analyzed 465 consecutive LTs (no-EDC, n=112; EDC ≥1, n=353) and examined the EDC (donor age >65 years, mechanical ventilation >7 days, aminotransferases >3x normal, bilirubin >3mg/dL, serum-Na+ >165mmol/L, positive hepatitis serology, macrosteatosis >40%, BMI >30, cold ischemia time (CIT) >14h, malignancy-, and drug abuse history). We aimed to identify the most relevant EDC and a combination thereof predictive of primary non-function (PNF), delayed non-function (DNF), short- (90 days), and long-term (5 year) graft failure. Results: Graft survival did not differ significantly between the LT-cases of no-EDC and EDC ≥1. The multivariate analysis identified macrosteatosis (HR 5.5 95%CI 1.9-16.0, p=0.002), donor age (HR 1.9 95%CI 1.1-3.5, p=0.034), and CIT (HR 2.0 95%CI 1.0-3.9, p=0.052) to be predictive of graft failure. Their combination affected both short- and long-term graft survival (p=0.041 and 0.002), which was also observed after controlling for labMELD with a cut-off value of 20 (p=0.023 and 0.001). Conclusion: Our analysis identified three parameters that clearly outweighed the rest of the EDC. The combination of fatty liver, older donors and long ischemia time worsens short- and long-term graft survival and also puts the graft at risk irrespective of recipient’s labMELD-score.
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