Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 9:29:e941931.
doi: 10.12659/AOT.941931.

Retrospective Analysis of the Impact of High- and Low-Quality Donor Livers for Patients with High-Acuity Illness

Ron K Varghese  1 , Greta E Handing  2 , Ashley E Montgomery  2 , Abbas A Rana  3 , John A Goss  3
Affiliations

Retrospective Analysis of the Impact of High- and Low-Quality Donor Livers for Patients with High-Acuity Illness

Ron K Varghese et al. Ann Transplant. .

Abstract

BACKGROUND Patients with high-acuity liver failure have increased access to marginal and split liver options, owing to historically high waitlist mortality rates. While most research states that donor liver quality has no impact on patients with high-acuity illness, there have been inconsistencies in recent research on how liver quality impacts post-transplant outcomes for these patients. We aimed to quantify donor liver quality with various post-transplantation patient outcomes for patients with high-acuity illness. MATERIAL AND METHODS Using the liver donor risk index (LDRI), model for end stage liver disease (MELD), and clinically relevant recipient factors, we used multivariate logistic regression to analyze how donor liver quality affects varying measures of patient outcomes for 9923 high-acuity patients from June 18, 2013, to June 18, 2022. RESULTS Using LDRI, high-quality livers had a significant protective impact on high-acuity patient mortality, compared with low-quality livers (OR=0.695 [0.549, 0.879], P=0.002). High-quality livers also had significant impact on graft survival (OR=0.706 [0.558, 0.894], P=0.004). Two sensitivity patient mortality analyses, excluding patients with status 1A and hepatocellular carcinoma, showed significant protective findings for high-quality livers. High-quality livers had insignificant outcomes on long-term survivor mortality, length of hospitalization, and primary non-function outcomes, compared with low-quality donor livers. CONCLUSIONS While our findings suggest donor quality has an impact on high-acuity patient outcomes, these findings indicate further research is needed in intent-to-treat analysis on clinical offer data to provide a clearer finding of how donor quality affects patients with high-acuity illness.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Study population exclusion criteria. A total of 72,918 patients who received liver transplants from June 18, 2013, to June 18, 2022 were assessed for eligibility. The figure displays exclusion criteria used to select the 9923 patients included in this analysis. StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: Stata Corp LLC.
Figure 2
Figure 2
Kaplan-Meier curve for survival in patients with MELD scores ≥35. (A) Patient survival shows significant difference for high- and normal-quality donors, compared with low-quality donors (log-rank, P<0.001 and P=0.02, respectively. (B) Graft survival shows significant differences for high- and normal-quality donors, compared with low-quality donors (log-rank, P<0.001 and P<0.001, respectively). StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC.
Figure 3
Figure 3
Long-term (1 year) survivor patient mortality. Insignificant differences were found for high- and normal-quality donors, compared with low-quality donors (log-rank, P=0.19 and P=0.11, respectively). StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC.
Figure 4
Figure 4
Primary non-function by liver quality. Low-, normal-, and high-quality donors make up 2.52%, 2.13%, and 2.07% of patients, respectively, with MELD scores ≥35. Log-rank testing shows insignificant differences for high- and low-quality donors, compared with normal-quality donors. StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Sharma P, Schaubel DE, Gong Q, et al. End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates. Hepatology. 2012;55(1):192–98. Erratum in: Hepatology. 2012;55(4):1311. - PMC - PubMed
    1. Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4):783–90. Erratum in: Am J Transplant. 2018;18(12):3085. - PubMed
    1. Zhang T, Dunson J, Kanwal F, et al. Trends in outcomes for marginal allografts in liver transplant. JAMA Surg. 2020;155(10):926–32. Erratum in: JAMA Surg. 2020;155(10):1002. - PMC - PubMed
    1. Rana A, Gruessner A, Agopian VG, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150(3):252–59. - PubMed
    1. Smith JM, Biggins SW, Haselby DG, et al. Kidney, pancreas and liver allocation and distribution in the United States. Am J Transplant. 2012;12(12):3191–212. - PMC - PubMed