Single-Center Experience Using Marginal Liver Grafts in Korea

P. J. Park, Young-Dong Yu, Y. I. Yoon, S. R. Kim, Dong-Sik Kim

Research output: Contribution to journalArticle

Abstract

Background: Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called “marginal donors.” Methods: We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30%, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). Results: A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5%, 75%, and 69.2% and 85.9%, 83.6%, and 77.2%, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P =.023 and P =.048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR], 4.862 [95% confidence interval (CI), 1.233–19.171]; P =.024) and occurrence of postoperative complications (HR, 4.547 [95% CI, 1.279–16.168]; P =.019) were significantly associated with worse patient overall survival. Also, when factors associated with marginal graft were analyzed separately, graft steatosis >30% was independently associated with survival (HR, 5.947 [95% CI, 1.481–23.886]; P =.012). Conclusions: Patients receiving marginal grafts showed lower but acceptable overall survival and graft survival. However, because graft steatosis >30% was independently associated with worse survival, caution must be exercised when using this type of marginal graft by weighing the risk and benefits.

Original languageEnglish
Pages (from-to)1147-1152
Number of pages6
JournalTransplantation Proceedings
Volume50
Issue number4
DOIs
Publication statusPublished - 2018 May 1

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Korea
Transplants
Liver
Tissue Donors
Survival
Liver Transplantation
End Stage Liver Disease
Graft Survival
Confidence Intervals
Cold Ischemia
Incidence
Cytomegalovirus Infections
Hepatitis B virus
Hepacivirus
Allografts
Liver Diseases
Hepatocellular Carcinoma
Length of Stay
Multivariate Analysis
Sodium

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Single-Center Experience Using Marginal Liver Grafts in Korea. / Park, P. J.; Yu, Young-Dong; Yoon, Y. I.; Kim, S. R.; Kim, Dong-Sik.

In: Transplantation Proceedings, Vol. 50, No. 4, 01.05.2018, p. 1147-1152.

Research output: Contribution to journalArticle

Park, P. J. ; Yu, Young-Dong ; Yoon, Y. I. ; Kim, S. R. ; Kim, Dong-Sik. / Single-Center Experience Using Marginal Liver Grafts in Korea. In: Transplantation Proceedings. 2018 ; Vol. 50, No. 4. pp. 1147-1152.
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title = "Single-Center Experience Using Marginal Liver Grafts in Korea",
abstract = "Background: Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called “marginal donors.” Methods: We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30{\%}, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). Results: A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5{\%}, 75{\%}, and 69.2{\%} and 85.9{\%}, 83.6{\%}, and 77.2{\%}, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P =.023 and P =.048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR], 4.862 [95{\%} confidence interval (CI), 1.233–19.171]; P =.024) and occurrence of postoperative complications (HR, 4.547 [95{\%} CI, 1.279–16.168]; P =.019) were significantly associated with worse patient overall survival. Also, when factors associated with marginal graft were analyzed separately, graft steatosis >30{\%} was independently associated with survival (HR, 5.947 [95{\%} CI, 1.481–23.886]; P =.012). Conclusions: Patients receiving marginal grafts showed lower but acceptable overall survival and graft survival. However, because graft steatosis >30{\%} was independently associated with worse survival, caution must be exercised when using this type of marginal graft by weighing the risk and benefits.",
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T1 - Single-Center Experience Using Marginal Liver Grafts in Korea

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AU - Yu, Young-Dong

AU - Yoon, Y. I.

AU - Kim, S. R.

AU - Kim, Dong-Sik

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N2 - Background: Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called “marginal donors.” Methods: We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30%, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). Results: A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5%, 75%, and 69.2% and 85.9%, 83.6%, and 77.2%, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P =.023 and P =.048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR], 4.862 [95% confidence interval (CI), 1.233–19.171]; P =.024) and occurrence of postoperative complications (HR, 4.547 [95% CI, 1.279–16.168]; P =.019) were significantly associated with worse patient overall survival. Also, when factors associated with marginal graft were analyzed separately, graft steatosis >30% was independently associated with survival (HR, 5.947 [95% CI, 1.481–23.886]; P =.012). Conclusions: Patients receiving marginal grafts showed lower but acceptable overall survival and graft survival. However, because graft steatosis >30% was independently associated with worse survival, caution must be exercised when using this type of marginal graft by weighing the risk and benefits.

AB - Background: Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called “marginal donors.” Methods: We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30%, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). Results: A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5%, 75%, and 69.2% and 85.9%, 83.6%, and 77.2%, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P =.023 and P =.048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR], 4.862 [95% confidence interval (CI), 1.233–19.171]; P =.024) and occurrence of postoperative complications (HR, 4.547 [95% CI, 1.279–16.168]; P =.019) were significantly associated with worse patient overall survival. Also, when factors associated with marginal graft were analyzed separately, graft steatosis >30% was independently associated with survival (HR, 5.947 [95% CI, 1.481–23.886]; P =.012). Conclusions: Patients receiving marginal grafts showed lower but acceptable overall survival and graft survival. However, because graft steatosis >30% was independently associated with worse survival, caution must be exercised when using this type of marginal graft by weighing the risk and benefits.

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