Gong JL, Yu J, Wang TL, He XS, Tang YH, Zhu XF. Application of extended criteria donor grafts in liver transplantation for acute-on-chronic liver failure: A retrospective cohort study. World J Gastroenterol 2023; 29(41): 5630-5640 [PMID: 38077155 DOI: 10.3748/wjg.v29.i41.5630]
Corresponding Author of This Article
Xiao-Feng Zhu, MD, PhD, Professor, Surgeon, Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road, Guangzhou 510080, Guangdong Province, China. zhuxiaof@mail.sysu.edu.cn
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jin-Long Gong, Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan Province, China
Jin-Long Gong, Jia Yu, Tie-Long Wang, Xiao-Shun He, Yun-Hua Tang, Xiao-Feng Zhu, Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Jia Yu, Department of Gastroenterology Surgery, The First Affiliated Hospital of University of South China, Hengyang 421005, Hunan Province, China
Author contributions: Gong JL, Tang YH, and Zhu XF conceived study; Gong JL, Yu J and Wang TL collected data and analyzed data; Yu J and Wang TL prepared figures and tables; Gong JL and Yu J wrote manuscript; He XS, Tang YH, and Zhu XF reviewed manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The datasets of the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Feng Zhu, MD, PhD, Professor, Surgeon, Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road, Guangzhou 510080, Guangdong Province, China. zhuxiaof@mail.sysu.edu.cn
Received: August 23, 2023 Peer-review started: August 23, 2023 First decision: September 11, 2023 Revised: September 24, 2023 Accepted: October 23, 2023 Article in press: October 23, 2023 Published online: November 7, 2023
Abstract
BACKGROUND
There is no consensus on the usage of extended criteria donor (ECD) grafts in liver transplantation (LT) for acute-on-chronic liver failure (ACLF) patients.
AIM
To summarize the experience of using ECD livers in ACLF-LT.
METHODS
A retrospective cohort study was conducted, enrolling patients who underwent LT at the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to November 2021. The patients were divided into ECD and non-ECD groups for analysis.
RESULTS
A total of 145 recipients were enrolled in this study, of which ECD and non-ECD recipients accounted for 53.8% and 46.2%, respectively. Donation after cardiac death (DCD) recipients accounted for the minority compared with donation after brain death (DBD) recipients (16.6% vs 83.4%). Neither overall survival nor graft survival significantly differed between ECD and non-ECD and DCD and DBD recipients. ECD grafts were associated with a significantly higher incidence of early allograft dysfunction (EAD) than non-ECD grafts (67.9% vs 41.8%, P = 0.002). Postoperative outcomes between DCD and DBD recipients were comparable (P > 0.05). ECD graft (P = 0.009), anhepatic phase (P = 0.034) and recipient gamma glutamyltransferase (P = 0.016) were independent risk factors for EAD. Recipient preoperative number of extrahepatic organ failures > 2 (P = 0.015) and intraoperative blood loss (P = 0.000) were independent predictors of poor post-LT survival.
CONCLUSION
Although related to a higher risk of EAD, ECD grafts can be safely used in ACLF-LT. The main factors affecting post-LT survival in ACLF patients are their own severe preoperative disease and intraoperative blood loss.
Core Tip: This manuscript is intended to summarize a Chinese single center experience of using extended criteria donor (ECD) grafts in liver transplantation (LT) for acute-on-chronic liver failure (ACLF) patients. In this paper, we found that under ECD grafts are associated with a higher risk of early allograft dysfunction than non-ECD grafts but can be safely used in ACLF recipients as they do not affect post-LT survival. The main factors affecting the prognosis of ACLF recipients are the severity of their own preoperative disease and intraoperative blood loss.
