Expanded criteria liver donors (ECD): effect of cumulative risks

Area of Science:

• Transplantation immunology
• Hepatology
• Organ donation and procurement

Background:

• Extended criteria donors (ECD) are defined by specific unfavorable characteristics, increasing the risk of primary non-function (PNF) after liver transplantation (LTX).
• The German Medical Association (2004) established criteria for ECD, including age > 65 years, BMI > 30 kg/m², elevated bilirubin or transaminases, and significant steatosis.

Purpose of the Study:

• To assess the impact of cumulated ECD criteria on graft utilization and one-year graft function rates in liver transplantation.
• To determine the predictive value of ECD criteria for graft outcomes.

Main Methods:

• A retrospective analysis of 422 consecutive liver donors between 1992 and 2004, with 282 liver grafts transplanted.
• Cumulated ECD criteria (sigmaECD) were calculated per donor and correlated with graft procurement rates and one-year graft function, accounting for PNF.
• Receiver-Operating-Characteristics (ROC) analysis was used to evaluate discrimination.

Main Results:

• Increasing sigmaECD significantly decreased graft procurement rates (from 95% for sigmaECD=0 to 13% for sigmaECD ≥ 4).
• One-year graft function rates diminished with higher sigmaECD, particularly when censored for PNF (0% function for sigmaECD ≥ 4).
• A sigmaECD of 0-1 versus 2-5 provided the best discrimination for graft utilization (sensitivity 55%, specificity 87%). Grafts with severe steatosis showed no function.

Conclusions:

• While cumulated ECD criteria are associated with an increased risk of PNF, utilizing these grafts can expand the limited donor pool.
• Careful donor selection and regional allocation of ECD livers are crucial to minimize ischemic-reperfusion injury and optimize outcomes.
• ECD livers can be successfully transplanted, but their use necessitates careful management to mitigate risks.