Hong et al developed a predictive index for a liver transplant recipient with liver harvested from a patient dying after cardiac death. Careful selection of the recipient and assessment of the donor liver can improve graft failure-free survival. The authors are from Dumont-UCLA Liver Cancer and Transplant Centers and the University of California Los Angeles.
Patient: liver transplant with organ from donor having a cardiac death
Outcome: graft failure-free survival
Parameters:
(1) diagnosis in recipient
(2) previous orthotopic liver transplant (OLT)
(3) body mass index (BMI)
(4) donor HBV core antibody
(5) mean arterial pressure < 60 mm Hg for > 20 minutes after withdrawal of life support
(6) cold ischemia time for liver in minutes
|
Parameter
|
Finding
|
Points
|
|
diagnosis
|
HCV and malignancy
|
3
|
|
|
malignancy without HCV
|
2
|
|
|
HCV without malignancy
|
2
|
|
|
other
|
0
|
|
previous OLT
|
no
|
0
|
|
|
yes
|
2
|
|
BMI
|
<= 30 kg per square meter
|
0
|
|
|
> 30 kg per square meter
|
1
|
|
donor HBVcore antibody
|
negative
|
0
|
|
|
positive
|
1
|
|
MAP
|
no
|
0
|
|
|
yes
|
1
|
|
cold ischemia time
|
<= 360 minutes (6 hours)
|
0
|
|
|
> 360 minutes
|
1
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the risk the worse the graft failure-free survival.
• A patient at high-risk is not a suitable candidate for a transplant of a liver harvested after cardiac death.
|
Score
|
Risk Group
|
Survival at 24 months
|
|
0 or 1
|
low
|
95%
|
|
2 to 4
|
intermediate
|
74%
|
|
5 to 9
|
high
|
15%
|
Ideal donor after cardiac death:
(1) age , 45 years of age
(2) body mass index < 30 kg per square meter
(3) hospitalization <= 5 days
(4) serum transaminases less than 2 times the upper limit of normal
(5) live support withdrawn in operating room
(6) liver parenchyma quality excellent at intraoperative assessment
