• Annals of surgery · Nov 2024

    Multicenter Study

    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 Nov 1; 280 (5): 896904896-904.

    ObjectiveTo evaluate the outcome of marginal liver grafts based on the Eurotransplant extended criteria donor (ECD) criteria.BackgroundEurotransplant uses a broad definition of ECD criteria (age >65 years, steatosis >40%, body mass index >30 kg/m 2 , intensive care unit stay >7 days, donation after circulatory death, 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 and the U.S. Scientific Registry of Transplant Recipients (SRTR) from 2006 to 2016. Results were validated with recent SRTR data (2017-2022). Donors were classified according to the Eurotransplant ECD criteria, donation after circulatory death was excluded. Data were analyzed with cutoff 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 body mass index in the United States (28%). Except for donor age, grafts meeting ECD criteria were not associated with impaired 1 or 3-year survival. Cutoffs had little to no predictive value for 30-day graft survival (area under the receiver operating curve: 0.49-0.52) and were nominally higher for age (72 vs 65 years) in Germany as compared with 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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