Application of extended criteria donor grafts in liver transplantation for acute-on-chronic liver failure: A retrospective cohort study

Table 1 Baseline characteristics of recipients, n (%)

	ECD (n = 78)	Non-ECD (n = 67)	P value
MELD	30.73 ± 5.96	30.19 ± 5.60	0.579
MELD			0.547
> 30	40 (51.3)	31 (46.3)
≤ 30	38 (48.7)	36 (53.7)
OFs			0.591
0	25 (32.1)	28 (41.8)
1	33 (42.3)	20 (29.9)
2	11 (14.1)	9 (13.4)
3	7 (9)	8 (11.9)
4	2 (2.6)	2 (3)
OFs			0.547
> 2	9 (11.5)	10 (14.9)
≤ 2	69 (88.5)	57 (85.1)
Age (yr)			0.365
> 60	4 (5.1)	6 (9)
≤ 60	74 (94.9)	61 (91)
Sex			0.730
Male	69 (88.5)	58 (86.6)
Female	9 (11.5)	9 (13.4)
BMI (kg/m2)			0.611
> 30	5 (6.4)	3 (4.5)
≤ 30	73 (93.6)	64 (95.5)
Blood group			0.411
O	29 (37.2)	28 (41.8)
A	24 (30.8)	20 (29.9)
B	22 (28.2)	13 (19.4)
AB	3 (3.8)	6 (9)
WBC (× 109/L)	6.84 ± 3.56	6.35 ± 3.52	0.411
N/L	6.27 ± 6.34	7.00 ± 6.12	0.482
Hb (g/L)	94.27 ± 22.29	89.45 ± 19.06	0.167
GGT (U/L)	49.51 ± 26.39	50.12 ± 32.49	0.901
ALB (g/L)	36.87 ± 4.94	38.37 ± 4.99	0.071
ALT (U/L)	85.33 ± 96.36	60.88 ± 75.02	0.088
AST (U/L)	114.47 ± 103.80	92.42 ± 82.42	0.163
PLT (× 109/L)	63.50 ± 33.83	62.49 ± 38.57	0.867
Fib (g/L)	1.02 ± 0.47	1.12 ± 0.43	0.176
IFLT	2 (2.6)	5 (7.5)	0.170

MELD: Model for end-stage liver disease; ECD: Extended criteria donor; OFs: Organ failures; BMI: Body mass index; WBC: White blood cell; Hb: Hemoglobin; GGT: Gamma glutamyltransferase; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PLT: Platelets; Fib: Fibrinogen; IFLT: Ischemia-free liver transplantation.

Table 2 Baseline characteristics of donor livers, n (%)

	ECD (n = 78)	Non-ECD (n = 67)	P value
DCD/DBD	24 (30.8)/54 (69.2)	0/ 67 (100)	0.000
Split	1 (1.3)	0	0.352
Macrovesicular steatosis			0.187
≥ 30	2 (2.6)	0
< 30	76 (97.4)	67 (100)
Age (yr)			0.352
> 65	1 (1.3)	0
≤ 65	77 (98.7)	67 (100)
BMI (kg/m2)			0.004
> 30	9 (11.5)	0
≤ 30	69 (88.5)	67 (100)
Na (mmol/L)			0.000
> 165	14 (17.9)	0
≤ 165	64 (82.1)	67 (100)
ALT (U/L)			0.000
> 120	23 (29.5)	0
≤ 120	55 (70.5)	67 (100)
AST (U/L)			0.000
> 120	36 (46.2)	0
≤ 120	42 (53.8)	67 (100)
TB (μmol/L)			0.012
> 51	7 (9.0)	0
≤ 51	71 (91.0)	67 (100)
CIT (h)			0.035
> 12	5 (6.4)	0
≤ 12	73 (93.6)	67 (100)
Reason of death			0.969
Trauma	41 (52.6)	35 (52.2)
Other	37 (47.4)	32 (47.8)

DCD: Donation after cardiac death; DBD: Donation after brain death; ECD: Extended criteria donor; BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; CIT: Cold-ischemia time.

Table 3 Secondary outcomes of recipients between extended criteria donor and non-extended criteria donor grafts, n (%)

	ECD (n = 78)	Non-ECD (n = 67)	P value
EAD	53 (67.9)	28 (41.8)	0.002
AKI	34 (43.6)	30 (44.8)	0.886
Blood loss (mL)	2.55 ± 1.70	2.82 ± 2.93	0.489
RBC transfused (U)	7.89 ± 3.93	9.13 ± 6.18	1.148
Plasma transfused (U)	9.77 ± 4.28	10.23 ± 4.51	0.534
Operative time (h)	7.48 ± 1.23	7.35 ± 1.37	0.554
ICU stay (d)	4.68 ± 4.95	4.63 ± 6.27	0.958

EAD: Early allograft dysfunction; ECD: Extended criteria donor; AKI: Acute kidney injury; ICU: Intensive care unit; RBC: Red blood cell.

Table 4 Secondary outcomes of recipients between donation after cardiac death and donation after brain death grafts, n (%)

	DCD (n = 24)	DBD (n = 121)	P value
EAD	17 (70.8)	64 (52.9)	0.106
AKI	11 (45.8)	53 (43.8)	0.855
Blood loss (mL)	2.53 ± 1.81	2.70 ± 2.44	0.747
RBC transfused (U)	8.61 ± 3.77	8.43 ± 5.35	0.876
Plasma transfused (U)	9.17 ± 5.03	10.14 ± 4.24	0.319
Operative time (h)	7.67 ± 1.46	7.37 ± 1.26	0.298
ICU stay (d)	5.25 ± 5.00	4.54 ± 5.70	0.571

DCD: Donation after cardiac death; DBD: Donation after brain death; ECD: Extended criteria donor; AKI: Acute kidney injury; ICU: Intensive care unit; RBC: Red blood cell.

Table 5 Univariable and multivariable logistic analysis of risk factors for early allograft dysfunction

Variables	OR	Univariate analysis		OR	Multivariate analysis
		HR (95%CI)	P value		HR (95%CI)	P value
Donor characteristics
HBV (positive vs negative)	1.076	0.522-2.220	0.843
Death of trauma (yes vs no)	1.331	0.689-2.568	0.395
ECD (yes vs no)	2.953	1.497-5.826	0.002	2.712	1.286-5.720	0.009
Operation characteristics
Blood loss (L)	1.080	0.925-1.262	0.330
Anhepatic phase (min)	1.036	1.012-1.060	0.003	1.031	1.002-1.060	0.034
Operation time (h)	1.487	1.124-1.967	0.005	1.271	0.915-1.767	0.153
IFLT (yes vs no)	0.121	0.014-1.031	0.053	0.114	0.011-1.218	0.072
Recipient characteristics
BMI (> 30 vs ≤ 30)	0.779	0.187-3.244	0.732
MELD (> 30 vs ≤30)	1.455	0.753-2.812	0.265
OFs (> 2 vs ≤ 2)	0.861	0.327-2.264	0.761
WBC (× 109/L)	1.039	0.945-1.142	0.432
N/L	0.997	0.946-1.051	0.906
Hb (g/L)	1.006	0.990-1.022	0.444
GGT (U/L)	1.015	1.002-1.029	0.027	1.017	1.003-1.032	0.016
ALB (g/L)	1.052	0.984-1.126	0.139
ALT (U/L)	1.002	0.998-1.006	0.288
AST (U/L)	1.001	0.997-1.004	0.650
PLT (× 109/L)	1.001	0.992-1.010	0.800
Fib (g/L)	0.692	0.332-1.441	0.325

OR: Odds ratio; CI: Confidence interval; HBV: Hepatitis B virus; ECD: Extended criteria donor; BMI: Body mass index; IFLT: Ischemia-free liver transplantation; MELD: Model for end-stage liver disease; OFs: Organ failures; WBC: White blood cell; Hb: Hemoglobin; GGT: Gamma glutamyltransferase; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PLT: Platelets; Fib: Fibrinogen.

Table 6 Univariable and multivariable Cox analysis of risk factors for overall survival

Variables	OR	Univariate analysis		OR	Multivariate analysis
		HR (95%CI)	P value		HR (95%CI)	P value
Donor characteristics
HBV (positive vs negative)	1.478	0.646-3.383	0.355
Death of trauma (yes vs no)	0.848	0.379-1.898	0.688
ECD (yes vs no)	1.053	0.465-2.386	0.901
No. of ECD features (≥ 2 vs < 2)	0.840	0.279-2.531	0.757
Operation characteristics
Blood loss (L)	1.271	1.137-1.421	0.000	1.276	1.123-1.449	0.000
Anhepatic phase (min)	1.009	0.989-1.028	0.381
Operation time (h)	1.002	0.746-1.345	0.990
IFLT (yes vs no)	0.822	0.111-6.107	0.848
EAD (yes vs no)	2.726	1.009-7.365	0.048	2.481	0.914-6.737	0.075
AKI (yes vs no)	1.882	0.830-4.269	0.130
Recipient characteristics
BMI (> 30 vs ≤ 30)	0.831	0.112-6.166	0.856
MELD (> 30 vs ≤ 30)	1.528	0.678-3.444	0.307
OFs (> 2 vs ≤ 2)	3.191	1.309-7.780	0.011	3.042	1.245-7.432	0.015
WBC (× 109/L)	1.007	0.897-1.129	0.912
N/L	1.040	0.992-1.090	0.102
Hb (g/L)	0.984	0.963-1.005	0.128
GGT (U/L)	0.986	0.968-1.005	0.142
ALB (g/L)	1.044	0.963-1.131	0.300
ALT (U/L)	0.992	0.984-1.001	0.070
AST (U/L)	0.998	0.992-1.004	0.463
PLT (× 109/L)	0.999	0.987-1.010	0.813
Fib (g/L)	0.874	0.345-2.211	0.775

OR: Odds ratio; CI: Confidence interval; HBV: Hepatitis B virus; ECD: Extended criteria donor; EAD: Early allograft dysfunction; BMI: Body mass index; IFLT: Ischemia-free liver transplantation; AKI: Acute kidney injury; MELD: Model for end-stage liver disease; OFs: Organ failures; WBC: White blood cell; Hb: Hemoglobin; GGT: Gamma glutamyltransferase; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PLT: Platelets; Fib: Fibrinogen.