Success of liver transplantation may be most influenced by three risk factors

CHICAGO Three risk factors: donor age; the length of time an organ is cooled between procurement and transplantation; and how urgently the recipient needs the transplant; have the greatest impact on patient and graft survival rates for liver transplantation, according to an article in the March issue of Archives of Surgery, one of the JAMA/Archives journals.

Almost 2,000 people with end-stage liver disease die every year waiting for a suitable donor liver, according to background information in the article. In 2000, there were almost 17,000 candidates awaiting liver transplant and only 5,000 transplanted. In an effort to expand the donor pool, organs from donors that are not judged optimum for a variety of reasons are being considered for possible transplant. Determining which factors have the most impact on patient and graft survival rates could help increase the donor pool and shorten the wait for liver transplantation, the authors suggest.

Derek E. Moore, M.D., of the Vanderbilt University Medical Center, Nashville, Tenn., and colleagues reviewed data on all adult patients who underwent liver transplant for end-stage liver disease at Vanderbilt University Medical Center between January 1, 1991 and July 31, 2003 to determine which of a number of previously identified risk factors had the greatest impact of the survival of the graft (the transplanted liver) and the survival of the patient. The researchers included three categories of risk factors in their analysis: donor characteristics, including age (whether the donor of the liver was older than 60) and weight (donor weight of more than 220 lbs.); technical characteristics, including cold ischemia time (CIT, the length of time an organ is cooled between procurement and transplantation) equal to or greater than 12 hours, and graft to recipient sex mismatch (female graft to male recipient); and recipient risk factors, including the United Network for Organ Sharing (UNOS) urgency status (1 or 2A ve

Contact: John Howser
JAMA and Archives Journals

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