Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
Ann Surg. 2024 Nov 1;280(5):896-904. doi: 10.1097/SLA.0000000000006491. Epub 2024 Aug 13.
To evaluate the outcome of marginal liver grafts based on the Eurotransplant extended criteria donor (ECD) criteria.
Eurotransplant uses a broad definition of ECD criteria (age >65 years, steatosis >40%, body mass index >30 kg/m 2 , intensive care unit stay >7 days, donation after circulatory death, and certain laboratory parameters) for allocating organs to recipients who have consented to marginal grafts. Historically, marginal liver grafts were associated with increased rates of dysfunction.
Retrospective cohort analysis using the German Transplant Registry and the U.S. Scientific Registry of Transplant Recipients (SRTR) from 2006 to 2016. Results were validated with recent SRTR data (2017-2022). Donors were classified according to the Eurotransplant ECD criteria, donation after circulatory death was excluded. Data were analyzed with cutoff prediction, binomial logistic regression, and multivariate Cox regression.
The study analyzed 92,330 deceased brain-dead donors (87% SRTR) and 70,374 transplants (87% SRTR) in adult recipients. Predominant ECD factors were donor age in Germany (30%) and body mass index in the United States (28%). Except for donor age, grafts meeting ECD criteria were not associated with impaired 1 or 3-year survival. Cutoffs had little to no predictive value for 30-day graft survival (area under the receiver operating curve: 0.49-0.52) and were nominally higher for age (72 vs 65 years) in Germany as compared with those defined by current Eurotransplant criteria.
The outcome of transplanted grafts from higher risk donors was nearly equal to standard donors with Eurotransplant criteria failing to predict survival of marginal grafts. Modifying ECD criteria could improve graft allocation and potentially expand the donor pool.
评估基于欧洲器官分配组织扩展标准供者（ECD）标准的边缘供肝的结局。
欧洲器官分配组织使用广泛的 ECD 标准定义（年龄>65 岁、脂肪变性>40%、体重指数>30kg/m 2 、重症监护病房停留时间>7 天、心脏死亡后捐献以及某些实验室参数）来分配同意接受边缘供肝的受者的器官。历史上，边缘供肝与功能障碍发生率增加相关。
使用德国移植登记处和美国器官共享网络移植受者登记处（SRTR）从 2006 年至 2016 年进行回顾性队列分析。结果通过最近的 SRTR 数据（2017-2022 年）进行验证。根据欧洲器官分配组织的 ECD 标准对供者进行分类，排除心脏死亡后捐献。使用截止值预测、二项逻辑回归和多变量 Cox 回归分析数据。
该研究分析了 92330 例脑死亡供者（87%为 SRTR）和 70374 例成人受者的移植（87%为 SRTR）。在德国，主要的 ECD 因素是供者年龄（30%），在美国是体重指数（28%）。除供者年龄外，符合 ECD 标准的移植物与 1 年或 3 年存活率受损无关。截止值对 30 天移植物存活率几乎没有预测价值（受试者工作特征曲线下面积：0.49-0.52），并且与当前欧洲器官分配组织的标准相比，德国的截止值略高（72 岁与 65 岁）。
来自高风险供者的移植移植物的结局几乎与符合欧洲器官分配组织 ECD 标准的标准供者相同，这些标准未能预测边缘供肝的存活率。修改 ECD 标准可以改善移植物的分配，并可能扩大供者库。
