Liver Grafts with Major Extended Donor Criteria May Expand the Organ Pool for Patients with Hepatocellular Carcinoma
Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
Liver Cancer Center Heidelberg (LCCH), University of Heidelberg, 69120 Heidelberg, Germany
Department of Internal Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
Department of Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(10), 1692; https://doi.org/10.3390/jcm8101692
Received: 20 September 2019 / Accepted: 5 October 2019 / Published: 15 October 2019
(This article belongs to the Special Issue Liver Transplantation)
The major extended donor criteria (maEDC; steatosis >40%, age >65 years, and cold ischemia time >14 h) influence graft and patient outcomes after liver transplantation. Despite organ shortages, maEDC organs are often considered unsuitable for transplantation. We investigated the outcomes of maEDC organ liver transplantation in patients with hepatocellular carcinoma (HCC). Two hundred and sixty-four HCC liver transplant patients were eligible for analysis. Risk factor analysis was performed for early allograft dysfunction; primary nonfunction; 30-day and 90-day graft failure; and 30-day, 90-day, and 1-year patient mortality. One-year graft survival was higher in recipients of no-maEDC grafts. One-year patient survival did not differ between the recipients of no-maEDC and maEDC organs. The univariate and multivariate analyses revealed no association between maEDC grafts and one-year patient mortality. Graft survival differed between the recipients of no-maEDC and maEDC organs after correcting for a laboratory model of end-stage liver disease (labMELD) score with a cut-off value of 20, but patient survival did not. Patient survival did not differ between recipients who did and did not meet the Milan criteria and who received grafts with and without maEDC. Instead of being discarded, maEDC grafts may expand the organ pool for patients with HCC without impairing patient survival or recurrence-free survival.