Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2023; 15(2): 255-264
Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.255
Extended criteria brain-dead organ donors: Prevalence and impact on the utilisation of livers for transplantation in Brazil
Victoria S Braga, Amanda P C S Boteon, Heloisa B Paglione, Rafael A A Pecora, Yuri L Boteon
Victoria S Braga, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Amanda P C S Boteon, Heloisa B Paglione, Rafael A A Pecora, Yuri L Boteon, Transplant Centre, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
Author contributions: Boteon YL contributed to study conception and design; Boteon YL, Braga VS, Boteon APCS, and Paglione HB contributed to acquisition of data; Boteon YL, Braga VS, Boteon APCS, Paglione HB, and Pecora RAA contributed to analysis and interpretation of data; Boteon YL, Braga VS, Boteon APCS, Paglione HB, and Pecora RAA contributed to drafting of manuscript; Boteon YL, Braga VS, Boteon APCS, Paglione HB, and Pecora RAA contributed to critical revision of manuscript; all authors contributed to editing and approved the final version of the article.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Hospital Israelita Albert Einstein (Approval No. 4.696.905 CAAE 39704520.0.0000.0071).
Informed consent statement: Informed consent was waived for patients in the study because of the study's retrospective nature and the use of a retrospective database.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Yuri L Boteon, FACS, MD, PhD, Doctor, Professor, Surgeon, Transplant Centre, Hospital Israelita Albert Einstein, 2nd floor, Building A1, Office 200B, 627/701 Albert Einstein Avenue, São Paulo 05652-900, Brazil. yuri.boteon@einstein.br
Received: November 23, 2022
Peer-review started: November 23, 2022
First decision: December 9, 2022
Revised: December 17, 2023
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 27, 2023
Abstract
BACKGROUND

Despite its association with higher postoperative morbidity and mortality, the use of extended criteria donor (ECD) livers for transplantation has increased globally due to the high demand for the procedure.

AIM

To investigate the prevalence of ECD in donation after brain death (DBD) and its impact on organ acceptance for transplantation.

METHODS

Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre. The incidence of the Eurotransplant risk factors to define an ECD (ET-ECD) among DBD donors and the likelihood of organ acceptance over the years were analysed. The relationship between organ refusal for transplantation, the occurrence, and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.

RESULTS

A total of 1619 organ donors were evaluated. Of these, 78.31% (n = 1268) had at least one ET-ECD criterion. There was an increase in the acceptance of ECD DBD organs for transplantation (1 criterion: from 23.40% to 31.60%; 2 criteria: from 13.10% to 27.70%; 3 criteria: From 6.30% to 13.60%). For each addition of one ET-ECD variable, the estimated chance of organ refusal was 64.4% higher (OR 1.644, 95%CI 1.469-1.839, P < 0.001). Except for the donor serum sodium > 165 mmol/L (P = 0.310), all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.

CONCLUSION

A high prevalence of ECD DBD was observed. Despite the increase in their utilisation, the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.

Keywords: Liver transplantation, Extended criteria donors, Donation after brain death, Organ donation

Core Tip: To suffice the demand of patients on the waiting list, the use of extended criteria donor (ECD) organs for transplantation has become a global need. This large retrospective analysis of 1619 donations after brain death (DBD) donor offers to a transplant centre in Brazil applied the Eurotransplant manual criteria to indicate an ECD. The prevalence of ECD was 78.31%. Whilst there was an increase in ECD-DBD liver transplantation over the years. Still, the presence and number of extended donor criteria were associated with an increased chance of donor organ rejection for transplantation.