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 & GE; 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 & GE; 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.

The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres / Pescarissi, Claudia; Penzo, Beatrice; Ghinolfi, Davide; Lai, Quirino; Bindi, Lucia; Decarlis, Riccardo; Melandro, Fabio; Balzano, Emanuele; Desimone, Paolo; Decarlis, Luciano; Degasperi, Andrea; Biancofiore, Giandomenico L. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - 22:(2022). [10.1186/s12871-022-01932-x]

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

Lai, Quirino;Melandro, Fabio;
2022

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 & GE; 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 & GE; 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.
2022
complications; intensive care unit; liver transplantation; organ donation; perioperative care
01 Pubblicazione su rivista::01a Articolo in rivista
The perioperative period of liver transplantation from unconventional extended criteria donors: data from two high-volume centres / Pescarissi, Claudia; Penzo, Beatrice; Ghinolfi, Davide; Lai, Quirino; Bindi, Lucia; Decarlis, Riccardo; Melandro, Fabio; Balzano, Emanuele; Desimone, Paolo; Decarlis, Luciano; Degasperi, Andrea; Biancofiore, Giandomenico L. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - 22:(2022). [10.1186/s12871-022-01932-x]
File allegati a questo prodotto
File Dimensione Formato  
Pescarissi_The-perioperative-period_2022.pdf

accesso aperto

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Creative commons
Dimensione 706.08 kB
Formato Adobe PDF
706.08 kB Adobe PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1672079
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 0
social impact