RISK FACTORS IN CADAVERIC DONORS OF LIVERS PROCURED

FOR ELECTIVE AND URGENT RECIPIENTS

Edyta Karpeta1, Jarosław Czerwiński2,3, Dariusz Wasiak2, Piotr Małkowski2, Andrzej Chmura1

1Department of General and Transplant Surgery, Medical University of Warsaw2Department of Surgical and Transplant Nursing, Medical University of Warsaw3Polish Transplant Coordinating Centre Poltransplant

Liver procurement from non-standard donors has become justified and it may have specific reasons in cases of recipients who await for urgent transplantations.

On the other hand, it is known that for such recipients the results are better when organs are obtained from ideal not expanded-criteria donors. 

The aim of this study was to compare the characteristics of cadaveric donors whose livers were used in elective versus urgent transplantations for the purpose of assessment if indeed the differences exist in the biological quality of organs for these two groups of recipients.  

Introduction & Objectives

Materials & Methods

Characteristics of 582 cadaveric liver donors and of recipients who received organs from these donors in the years 2006-2008 were analyzed.

Donors and recipients were divided into two groups of transplantations: - elective – 387- urgent – 195

For the purpose of the study 12 donor related factors were analyzed:

age > 55 years alcohol ICU > 4 days hypotension

Noradrenaline > 0.1 ɣ anti-Hbcore (+) Na > 155 mmol/L INR > 1.5

AST > 140 U/L ALT > 170 U/L bilirubin > 2.0 changes in sonography

Materials & Methods

Two methods were used for calculation if the two groups of liver donors differed in the matter of clinical risk factors which would have possible impact on post-transplant function:

1)the comparison of frequency of particular risk factor incidence in both groups,

2)the comparison of the average number of risk factors documented in the group of liver donors for elective and in the group of donors for urgent recipients.

Chi-squared test and T-test were used for statistical analysis; p value of < 0.05 was considered as statistically significant.

Results: Frequency of donor risk factor incidence

Risk factors Transplantation urgency p=(chi-test)

Elective (N=387) Urgent (N=195)

Age > 55 years 49 (13%) 27 (14%) ns

Alcohol ingestion (yes) 31 (8%) 15 (8%) ns

ICU > 4 days 162 (42%) 85 (44%) ns

Hypotension (yes) 133 (34%) 69 (35%) ns

Noradrenaline > 0.1 µg/kg/min 104 (27%) 67 (34%) ns

Anti-HBcore(+) 31 (8%) 16 (8%) ns

INR > 1,5 57 (15%) 24 (12%) ns

AST > 140U/L 28 (7%) 14 (7%) ns

ALT > 170U/L 13 (3%) 4 (2%) ns

Bilirubin > 2.0 mg/dL 17 (4%) 11 (6%) ns

Changes in liver sonography 106 (27%) 48 (25%) ns

Na > 155 mEq/L 151 (39%) 59 (30%) p=0.04

Results: Mean number of risk factors

No risk factors Transplantation urgency All donors

(N= 582) Elective (N=387) Urgent (N=195)

0 26 (7%) 12 (6%) 38 (6%)

1 93 (24%) 39 (20%) 132 23%)

2 106 (28%) 66 (34%) 172 (31%)

3 98 (25%) 50 (26%) 148 (25%)

4 40 (10%) 16 (8%) 56 (9%)

5 19 (5%) 8 (4%) 27 (5%)

6 5 (1%) 4 (2%) 9 (1%)

Mean / per

donor

2.28 (± 1.32) 2.30 (± 1.28) p=0.87 (T-test)

Conclusions

1. In almost all cases of liver transplantations (94%) donor related risk factors are accepted

2. The criteria of cadaveric liver donors are not different in the group of donors for elective versus urgent recipients; biological characteristics of transplanted organs are comparable in both groups

3. The tendency to expand donor criteria for urgent recipients is not observed