BMC Anesthesiology (Dec 2022)

The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres

  • Claudia Pescarissi,
  • Beatrice Penzo,
  • Davide Ghinolfi,
  • Quirino Lai,
  • Lucia Bindi,
  • Riccardo DeCarlis,
  • Fabio Melandro,
  • Emanuele Balzano,
  • Paolo DeSimone,
  • Luciano DeCarlis,
  • Andrea DeGasperi,
  • Italian Collaborative Group on Liver Transplantation from Extended Criteria Donation,
  • Giandomenico L. Biancofiore

DOI
https://doi.org/10.1186/s12871-022-01932-x
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 8

Abstract

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Abstract Background As literature largely focuses on long-term outcomes, this study aimed at elucidating the perioperative outcomes of liver transplant patients receiving a graft from two groups of unconventional expanded criteria donors: brain dead aged > 80 years and cardiac dead. Methods Data of 247 cirrhotic patients transplanted at two high volume liver transplant centers were analysed. Confounders were balanced using a stabilized inverse probability therapy weighting and a propensity score for each patient on the original population was generated. The score was created using a multivariate logistic regression model considering a Comprehensive Complication Index ≥ 42 (no versus yes) as the dependent variable and 11 possible clinically relevant confounders as covariate. Results Forty-four patients received the graft from a cardiac-dead donor and 203 from a brain-dead donor aged > 80 years. Intraoperatively, cardiac-dead donors liver transplant cases required more fresh frozen plasma units (P < 0.0001) with similar reduced need of fibrinogen to old brain-dead donors cases. The incidence of reperfusion syndrome was similar (P = 0.80). In the Intensive Care Unit, both the groups presented a comparable low need for blood transfusions, renal replacement therapy and inotropes. Cardiac-dead donors liver transplantations required more time to tracheal extubation (P < 0.0001) and scored higher Comprehensive Complication Index (P < 0.0001) however the incidence of a severe complication status (Comprehensive Complication Index ≥ 42) was similar (P = 0.52). ICU stay (P = 0.97), total hospital stay (P = 0.57), in hospital (P = 1.00) and 6 months (P = 1.00) death were similar. Conclusion Selected octogenarian and cardiac-dead donors can be used safely for liver transplantation.

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