Background: An index that predicts liver allograft discard can effectively grade allografts and can be used to preferentially allocate marginal allografts to aggressive centers. The aim of this study is to devise an index to predict liver allograft discard using only risk factors available at the time of initial DonorNet offer.
Methods: Using univariate and multivariate analyses on a training set of 72 297 deceased donors, we identified independent risk factors for liver allograft discard. Multiple imputation was used to account for missing variables.
Results: We identified 15 factors as significant predictors of liver allograft discard; the most significant risk factors were: total bilirubin > 10 mg/dL (odds ratio [OR], 25.23; confidence interval [CI], 17.32-36.77), donation after circulatory death (OR, 14.13; CI, 13.30-15.01), and total bilirubin 5 to 10 mg/dL (OR, 7.57; 95% CI, 6.32-9.05). The resulting Discard Risk Index (DSRI) accurately predicted the risk of liver discard with a C statistic of 0.80. We internally validated the model with a validation set of 37 243 deceased donors and also achieved a 0.80 C statistic. At a DSRI at the 90th percentile, the discard rate was 50% (OR, 32.34; CI, 28.63-36.53), whereas at a DSRI at 10th percentile, only 3% of livers were discarded.
Conclusions: The use of the DSRI can help predict liver allograft discard. The DSRI can be used to effectively grade allografts and preferentially allocate marginal allografts to aggressive centers to maximize the donor yield and expedite allocation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TP.0000000000002151 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Group 1 innate lymphoid cells protect liver transplants from ischemia-reperfusion injury via an interferon-γ-mediated pathway.
Am J Transplant
December 2024
The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Department of Surgery, Medical University of South Carolina, Charleston, SC 29425. Electronic address:
As important immune regulatory cells, whether innate lymphoid cells (ILCs) are involved in liver transplantation (LT) remains unclear. In a murine orthotopic LT model, we dissected roles of ILCs in liver ischemia-reperfusion injury (IRI). Wild type (WT) grafts suffered significantly higher IRI in Rag2-γc double knockout (DKO) than Rag2 KO recipients, in association with downregulation of group 1 ILCs genes, including IFN-γ.
View Article and Find Full Text PDFCase report: Outflow reconstruction with pre-frozen allograft blood vessels during partial hepatectomy followed by tumor resection and partial liver autotransplantation for locally advanced hepatocellular carcinoma with background of cirrhosis.
Front Oncol
December 2024
Department of Organ Transplantation, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
surgery and autotransplantation may provide a promising option for radical resection of conventionally unresectable liver tumors. Two cirrhotic patients with hepatocellular carcinoma (HCC), which has an "awkward seat" located in the "intrahepatic vascular triangle area (IVTA)" that consists of the middle hepatic vein (MHV), the right branches of the Glisson sheath, and the inferior vena cava (IVC), underwent extended right-half hepatectomy followed by tumor resection and partial liver autotransplantation. Innovatively, the outflow of the tumor-free liver was reconstructed using pre-frozen allograft blood vessels from brain-dead donors; the patients recovered well postoperation.
View Article and Find Full Text PDFImmunoglobulin-like receptor genotype-associated protection from cytomegalovirus infection after liver transplantation.
Transpl Immunol
December 2024
Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China. Electronic address:
Background: Cytomegalovirus (CMV) is a common clinical infection especially after organ transplantation and threaten the survival of recipients. Natural killer (NK) cells play an important role in the process of CMV infection. In this study, we want to explore that if the different of killer immunoglobulin-like receptors (KIRs) of NK cells could affect CMV infection.
View Article and Find Full Text PDFTumor-derived CCL15 regulates RNA mA methylation in cancer-associated fibroblasts to promote hepatocellular carcinoma growth.
Cancer Lett
December 2024
Department of Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Digestive Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, P. R. China. Electronic address:
Hepatocellular carcinoma (HCC) is a lethal malignancy characterized by rapid growth. The interaction between tumor cells and cancer-associated fibroblasts (CAFs) significantly influences HCC progression. CCL15, a CC chemokine family member, is predominantly expressed in HCC and strongly correlates with tumor size, indicating its critical role in HCC growth.
View Article and Find Full Text PDFTwo-Dimensional Shear Wave Ultrasound Elastography for Monitoring Pediatric Liver Transplantation: A Review of Recent Advances.
Pediatr Transplant
February 2025
School of Medicine, RCSI Medical University of Bahrain, Busaiteen, Bahrain.
Pediatric liver transplantation (PLT) is a life-saving procedure for children with end-stage liver disease. However, post-transplant monitoring, particularly the diagnosis and prognosis of complications such as allograft fibrosis, remains challenging. Traditionally, liver biopsy has been the gold standard for assessing allograft fibrosis, despite its invasive nature and inherent procedural risks.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!