Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
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The use of high-risk donor livers, which is reflective of the gross national shortage of organs available for transplantation, has gained momentum. Despite the demand, many marginal livers are discarded annually. We evaluated the impact of center volume on survival outcomes associated with liver transplantation using high-donor risk index (DRI) allografts. ⋯ Multivariate risk-adjusted frailty models showed that increased procedure volume at a transplant center led to decreased risks of allograft failure [hazard ratio (HR) = 0.93, 95% confidence interval (CI) = 0.89-0.98, P = 0.002] and recipient death (HR = 0.90, 95% CI = 0.83-0.97, P = 0.004) for high-DRI liver transplants. In conclusion, HVCs more frequently used higher DRI livers and achieved better risk-adjusted allograft and recipient survival. A greater understanding of the outcomes of transplantation with high-DRI livers may improve their utilization, the postoperative outcomes, and future allocation practices.
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Several donor and graft characteristics are associated with higher failure rates for deceased donor liver transplantation (LT). The influence of reversible cardiac arrest in the donor on these failure rates is unclear because of scarce and inconsistent data. The aim of this study was to determine whether reversible cardiac arrest in the donor could affect the early postoperative outcome of LT. ⋯ Furthermore, the 2 groups had similar graft and patient survival rates at the 6-month mark (87% and 88%, respectively). In conclusion, our study shows that brief and reversible cardiac arrest in organ donors does not affect post-LT allograft survival and function, even though liver function test values are higher for these donors. However, the risk of using these grafts needs to be balanced against the potential benefits for the recipients.