The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis

Francesca M. Dimou, Hemalkumar Mehta, Deepak Adhikari, Robert C. Harland, Taylor S. Riall, Yong Fang Kuo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. Methods The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002–2014). Cox hazards models were created using (1) United Network for Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure. Results A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9%) patients received an ECD. Transplantation with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.91–1.23) between donor types but an increased risk of graft failure (HR 1.18, 95% CI 1.03–1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10% increase in KDPI was associated with a 28% increase in patient mortality (HR 1.28, 95% CI 1.02–1.60) and 45% increase in graft failure (HR 1.45, 95% CI 1.18–1.80). Conclusion Based on the current United Network for Organ Sharing definition, ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation.

Original languageEnglish (US)
Pages (from-to)1533-1543
Number of pages11
JournalSurgery (United States)
Volume160
Issue number6
DOIs
StatePublished - Dec 1 2016

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Liver Transplantation
Tissue Donors
Confidence Intervals
Transplants
Kidney
Proportional Hazards Models
Non-alcoholic Fatty Liver Disease
Liver
Cold Ischemia
Survival
Mortality
Graft Survival
Sex Characteristics
Cause of Death
Body Mass Index
Transplantation
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis. / Dimou, Francesca M.; Mehta, Hemalkumar; Adhikari, Deepak; Harland, Robert C.; Riall, Taylor S.; Kuo, Yong Fang.

In: Surgery (United States), Vol. 160, No. 6, 01.12.2016, p. 1533-1543.

Research output: Contribution to journalArticle

Dimou, Francesca M. ; Mehta, Hemalkumar ; Adhikari, Deepak ; Harland, Robert C. ; Riall, Taylor S. ; Kuo, Yong Fang. / The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis. In: Surgery (United States). 2016 ; Vol. 160, No. 6. pp. 1533-1543.
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abstract = "Background Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. Methods The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002–2014). Cox hazards models were created using (1) United Network for Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure. Results A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9{\%}) patients received an ECD. Transplantation with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95{\%} confidence interval [CI] 0.91–1.23) between donor types but an increased risk of graft failure (HR 1.18, 95{\%} CI 1.03–1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10{\%} increase in KDPI was associated with a 28{\%} increase in patient mortality (HR 1.28, 95{\%} CI 1.02–1.60) and 45{\%} increase in graft failure (HR 1.45, 95{\%} CI 1.18–1.80). Conclusion Based on the current United Network for Organ Sharing definition, ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation.",
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N2 - Background Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. Methods The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002–2014). Cox hazards models were created using (1) United Network for Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure. Results A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9%) patients received an ECD. Transplantation with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.91–1.23) between donor types but an increased risk of graft failure (HR 1.18, 95% CI 1.03–1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10% increase in KDPI was associated with a 28% increase in patient mortality (HR 1.28, 95% CI 1.02–1.60) and 45% increase in graft failure (HR 1.45, 95% CI 1.18–1.80). Conclusion Based on the current United Network for Organ Sharing definition, ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation.

AB - Background Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. Methods The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002–2014). Cox hazards models were created using (1) United Network for Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure. Results A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9%) patients received an ECD. Transplantation with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.91–1.23) between donor types but an increased risk of graft failure (HR 1.18, 95% CI 1.03–1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10% increase in KDPI was associated with a 28% increase in patient mortality (HR 1.28, 95% CI 1.02–1.60) and 45% increase in graft failure (HR 1.45, 95% CI 1.18–1.80). Conclusion Based on the current United Network for Organ Sharing definition, ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation.

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