• Annals of surgery · Aug 2024

    Multinational Analysis of Marginal Liver Grafts Based on the Eurotransplant Extended Donor Criteria.

    • Simon Moosburner, Madhukar S Patel, Benjamin K Wang, Jai Prasadh, Robert Öllinger, Georg Lurje, Igor M Sauer, Parsia A Vagefi, Johann Pratschke, and Nathanael Raschzok.
    • Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
    • Ann. Surg. 2024 Aug 13.

    ObjectiveTo evaluate the outcome of marginal liver grafts based on the Eurotransplant extended donor criteria (ECD) criteria.Summary Background DataEurotransplant uses a broad definition of ECD criteria (age >65 years, steatosis >40%, BMI >30 kg/m2, ICU stay >7 days, DCD, and certain laboratory parameters) for allocating organs to recipients who have consented to marginal grafts. Historically, marginal liver grafts were associated with increased rates of dysfunction.MethodsRetrospective cohort analysis using the German Transplant Registry (GTR) and the US Scientific Registry of Transplant Recipients (SRTR) from 2006-2016. Results were validated with recent SRTR data (2017-2022). Donors were classified according to the Eurotransplant ECD criteria, DCD was excluded. Data were analyzed with cut-off prediction, binomial logistic regression, and multivariate Cox regression.ResultsThe study analyzed 92,330 deceased brain-dead donors (87% SRTR) and 70,374 transplants (87% SRTR) in adult recipients. Predominant ECD factors were donor age in Germany (30%) and BMI in the US (28%). Except for donor age, grafts meeting ECD criteria were not associated with impaired 1- or 3-year survival. Cut-offs had little to no predictive value for 30-day graft survival (AUROC 0.49 - 0.52) and were nominally higher for age (72 vs. 65 years) in Germany as compared to those defined by current Eurotransplant criteria.ConclusionsThe outcome of transplanted grafts from higher risk donors was nearly equal to standard donors with Eurotransplant criteria failing to predict survival of marginal grafts. Modifying ECD criteria could improve graft allocation and potentially expand the donor pool.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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