A risk factor analysis of donor-specific factors on one- and threeyear post-transplant mortality after multi visceral transplantation

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Transplantation

Abstract

Background: Patients undergoing combined liver and intestine transplantation (multi visceral transplantation [MVT]) represent a particularly vulnerable patient population. These patients have specific quality requirements for suitable donors. We sought to evaluate the effects of various marginal donor qualities on posttransplant outcomes in MVT patients. Methods: The Organ Procurement and Transplantation Network/ United Network for Organ Sharing database was used to identify all adult recipients of liver and intestine listed between 01/01/2010 and 01/25/2021. Outcomes included 1- and 3-year post-transplant patient survival and mortality. Results: A total of 268 MVTs were identified. Of these, 232 were intestine-liver-pancreas, 32 were intestine-liver-kidney, and four were intestine-liver. Of the MVTs, donor age >40 was present in 36/268(13%), donor body mass index(BMI)>30 in 10/268(4%), donor diabetes 1/268(0%), any donor pressor requirement in 108/268(40%), and multiple donor pressor requirements in 11/268(4%). The 1- and 3-year survival for donor age <40 vs. ≥40 was 65.8% vs. 52.1%;p=0.13 and 50.1%vs.48.9%;p=0.53. Similarly, the 1- and 3-year survival for no donor pressor requirement vs. donor pressor requirement were 61.9%vs.67.5%;p=0.61 and 45.8% vs. 57.0%;p=0.24, respectively. The 1-year survival for various cold ischemia cutoffs were ≤6.50hr 64.4%vs.6.51-7.56hr 63.9%vs.7.57-8.79hr 69.8% vs. ≥8.80hr 57.6%;p=0.50 and 3-year survival for the various cutoffs were ≤6.50hr 50.4%vs.6.51-7.56hr 54.0%vs.7.57-8.79hr 47.0% vs. ≥8.80hr 47.9%;p=0.83(Figure 1). Conclusions: Donors with older age(>40yo), high BMI, and/or multiple pressor requirements were not often used for MVT probably due to its careful donor selection. While no statistically significant donor-specific risk factors were noted to be associated with posttransplant mortality, older donor age(>40yo) and longer CIT(≥8.8hr) tended to worsen short-term outcome(1-year survival). Within this context, to maintain appropriate outcomes, the choice of MVT donors should be selective. There may a room to expand donor pool/donor selection criteria in MVT without adversely impacting outcomes.

Volume

107

Issue

9

First Page

210

Last Page

211

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