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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Liver transplant outcomes using late allocation grafts.

Caroline C Jadlowiec1, Abigail Brooks2, Kylie Pont1

  • 1Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|July 11, 2023
PubMed
Summary

Late allocation liver allografts show similar patient and graft survival rates compared to standard allocation, despite longer cold ischemia times. Optimizing allocation policies and sharing best practices can reduce unnecessary liver discards.

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Area of Science:

  • Transplantation immunology
  • Hepatobiliary surgery
  • Organ procurement and allocation

Background:

  • Late allocation (LA) liver allografts face higher discard rates due to logistical challenges.
  • Standard allocation (SA) is the conventional method for liver allograft distribution.

Purpose of the Study:

  • To compare outcomes of liver transplants (LT) using LA allografts versus SA allografts.
  • To identify factors influencing the discard of LA liver allografts.
  • To evaluate the safety and efficacy of LA liver allografts.

Main Methods:

  • Nearest neighbor propensity score matching was used to compare LA and SA liver offers.
  • Logistic regression model included recipient age, sex, graft type, MELD, and DRI score.
  • A cohort of 101 liver transplants using LA offers between 2015 and 2021 was analyzed.

Main Results:

  • No significant differences were observed in recipient characteristics between LA and SA groups.
  • LA grafts originated from younger donors and were more likely from regional/national Organ Procurement Organizations (OPOs).
  • Cold ischemia time was longer for LA grafts, but patient and graft survival rates were comparable (1-year survival: 95.1% LA vs. 95.0% SA for patients; 93.1% LA vs. 92.1% SA for grafts).

Conclusions:

  • Liver transplantation outcomes using LA grafts are similar to those using SA grafts, despite increased logistical complexity and cold ischemia time.
  • Improving LA-specific allocation policies and fostering collaboration between transplant centers and OPOs can minimize allograft discards.
  • LA liver allografts represent a viable option for increasing the donor liver pool and improving access to transplantation.