Braga VS, Boteon APCS, Paglione HB, Pecora RAA, Boteon YL. Extended criteria brain-dead organ donors: Prevalence and impact on the utilisation of livers for transplantation in Brazil. World J Hepatol 2023; 15(2): 255-264 [PMID: 36926240 DOI: 10.4254/wjh.v15.i2.255]
Corresponding Author of This Article
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
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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Table 2 Descriptive analysis of donor extended criteria over the years, n (%)
Variable (year)
2017
2018
2019
2020
Total
Macroscopic assessment of steatosis in the organ
5 (1.99)
0 (0.00)
3 (0.66)
4 (0.89)
12 (0.74)
Age > 65 yr
35 (14.00)
69 (14.90)
67 (14.73)
52 (11.56)
223 (13.78)
ICU > 7 d
81 (32.27)
143 (30.89)
145 (31.87)
153 (34.00)
522 (32.24)
BMI > 30 kg/m2
61 (24.30)
82 (17.71)
90 (19.78)
80 (17.78)
313 (19.33)
Serum sodium > 165 mmol/L
39 (15.54)
82 (17.71)
73 (16.04)
64 (14.22)
258 (15.94)
AST > 90 U/L
72 (28.69)
172 (37.23)
184 (40.44)
187 (41.65)
615 (38.03)
ALT > 105 U/L
54 (21.51)
108 (23.38)
111 (24.45)
93 (20.71)
366 (22.65)
Total bilirubin > 3 mg/dL
6 (2.39)
13 (2.83)
25 (5.51)
18 (4.01)
62 (3.84)
Number of variables to classify a donor as an extended criteria donor
0
54 (21.51)
96 (20.73)
106 (23.30)
95 (21.11)
351 (21.68)
1
94 (37.45)
159 (34.34)
122 (26.81)
158 (35.11)
533 (32.92)
2
61 (24.30)
133 (28.73)
133 (29.23)
119 (26.44)
446 (27.55)
3
32 (12.75)
58 (12.53)
68 (14.95)
59 (13.11)
217 (13.40)
4
9 (3.59)
15 (3.24)
24 (5.27)
17 (3.78)
65 (4.01)
5
1 (0.40)
2 (0.43)
2 (0.44)
2 (0.44)
7 (0.43)
Table 3 Occurrence of donor extended criteria according to the year of offer
Variable
Odds ratio (95%CI)
P value
Absence of macroscopic steatosis in the donor organ
0.845 (0.491; 1.455)
0.545
Donor age > 65 yr
0.925 (0.808; 1.059)
0.259
ICU stay > 7 d
1.037 (0.938; 1.147)
0.473
BMI > 30 kg/m2
0.915 (0.813; 1.030)
0.140
Serum sodium > 165 mmol/L
0.943 (0.830; 1.071)
0.364
AST > 90 U/L
1.177 (1.068; 1.298)
0.001
ALT > 105 U/L
0.979 (0.876; 1.095)
0.717
Total bilirubin > 3 mg/dL
1.223 (0.952; 1.572)
0.116
≥ 1 donor extended criteria
0.991 (0.885; 1.110)
0.878
Table 4 Analysis of the relationship between the occurrence of donor extended criteria and the refusal rate of liver allografts for transplantation
Logistic regression for donor organ refusal for transplantation (n = 1619)
Variable
Odds ratio for refusal (95%CI)
P value
Absence of macroscopic steatosis in the donor organ
0.072 (0.016; 0.332)
< 0.001
Donor age > 65 yr
1.814 (1.264; 2.603)
0.001
ICU stay > 7 d
1.810 (1.408; 2.328)
< 0.001
BMI > 30 kg/m2
2.215 (1.601; 3.065)
< 0.001
Serum sodium > 165 mmol/L
1.173 (0.862; 1.596)
0.310
AST > 90 U/L
1.713 (1.352; 2.171)
< 0.001
ALT > 105 U/L
2.007 (1.493; 2.697)
< 0.001
Total bilirubin > 3 mg/dL
3.011 (1.361; 6.664)
0.007
Table 5 Analysis of the relationship between the occurrence of donor extended criteria and the refusal rate of liver allografts for transplantation
Multiple logistic regression model for donor organ refusal for transplantation (n = 1619)
Variable
Estimated proportionof refusal (95%CI)
Odds ratio for refusal (95%CI)
P value
Absence of macroscopic steatosis in the donor organ
41.10% (12.04%; 78.06%)
0.064 (0.013; 0.307)
< 0.001
Donor age > 65 yr
79.54% (59.84%; 91.02%)
1.973 (1.360; 2.861)
< 0.001
ICU stay > 7 d
79.18% (60.23%; 90.52%)
1.888 (1.455; 2.450)
< 0.001
BMI > 30 kg/m2
80.69% (62.19%; 91.39%)
2.279 (1.628; 3.190)
< 0.001
AST > 90 U/L
76.57% (56.61%; 89.11%)
1.394 (1.051; 1.848)
0.021
ALT > 105 U/L
78.44% (58.88%; 90.24%)
1.729 (1.217; 2.456)
0.002
Total bilirubin > 3 mg/dL
82.44% (60.00%; 93.63%)
2.877 (1.282; 6.454)
0.010
Citation: Braga VS, Boteon APCS, Paglione HB, Pecora RAA, Boteon YL. Extended criteria brain-dead organ donors: Prevalence and impact on the utilisation of livers for transplantation in Brazil. World J Hepatol 2023; 15(2): 255-264