Mohamed Chairi MH, Mogollón González M, Triguero Cabrera J, Segura Jiménez I, Villegas Herrera MT, Villar del Moral JM. Risk scores for allograft failure: Are they still useful in liver recipients from donation after circulatory death? World J Transplant 2024; 14(4): 97612 [DOI: 10.5500/wjt.v14.i4.97612]
Corresponding Author of This Article
Mohamed H Mohamed Chairi, PhD, Doctor, Medical Assistant, Surgeon, Transplant Surgery Division, Department of Surgery, Virgen de las Nieves University Hospital, Fuerzas Armadas Av. No. 2, Granada 18013, Andalusia, Spain. yasinmc1994@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2024; 14(4): 97612 Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.97612
Risk scores for allograft failure: Are they still useful in liver recipients from donation after circulatory death?
Mohamed H Mohamed Chairi, Mónica Mogollón González, Jennifer Triguero Cabrera, Inmaculada Segura Jiménez, Maria T Villegas Herrera, Jesús M Villar del Moral
Mohamed H Mohamed Chairi, Mónica Mogollón González, Jennifer Triguero Cabrera, Inmaculada Segura Jiménez, Maria T Villegas Herrera, Jesús M Villar del Moral, Transplant Surgery Division, Department of Surgery, Virgen de las Nieves University Hospital, Granada 18013, Andalusia, Spain
Co-corresponding authors: Mohamed H Mohamed Chairi and Mónica Mogollón González.
Author contributions: Mohamed Chairi MH and Mogollón González M contributed equally to this study as co-corresponding authors; Mohamed Chairi MH conducted the experiments and analyzed the data; Mogollón González M designed the experimental setup and assisted with data collection and interpretation; Triguero Cabrera J wrote the manuscript and prepared figures and tables for publication; Segura Jiménez I provided critical feedback and revisions to the manuscript before submission; Villegas Herrera MT contributed to literature review and provided insights on previous research relevant to the study; Villar del Moral JM supervised the project and provided overall guidance and direction.
Institutional review board statement: The study was reviewed and approved by the regional Research Ethics Committee Review Board (Approval No. 576).
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No grant has been received for the purpose of the study. No conflict of interests exist in relation to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed H Mohamed Chairi, PhD, Doctor, Medical Assistant, Surgeon, Transplant Surgery Division, Department of Surgery, Virgen de las Nieves University Hospital, Fuerzas Armadas Av. No. 2, Granada 18013, Andalusia, Spain. yasinmc1994@gmail.com
Received: June 3, 2024 Revised: July 17, 2024 Accepted: August 2, 2024 Published online: December 18, 2024 Processing time: 108 Days and 16.4 Hours
Abstract
BACKGROUND
Liver grafts from donation after circulatory death (DCD) are associated with a higher risk of early graft dysfunction, determined by the warm ischemia and cold ischemia times. It is essential to have precise criteria to identify this complication in order to guide therapeutic strategies.
AIM
To validate different graft and recipient survival scores in patients undergoing liver transplantation (LT) with DCD grafts.
METHODS
A retrospective and observational unicentric study was conducted on 65 LT patients with grafts obtained from controlled DCD donors from November 2013 to November 2022. The United Kingdom (UK) risk score, early allograft dysfunction (EAD) Olthoff score, and model for early allograft function (MEAF) score were used to evaluate the risk of graft and recipient survival post-transplant. For survival analysis purposes, we used the Kaplan-Meier method, and the differences between subgroups were compared using the log-rank (Mantel-Cox) test.
RESULTS
Sixty-five patients were included in the study. The UK risk score did not demonstrate predictive capacity for recipient or graft survival. However, in donors aged over 70 years old (18.4%), it significantly predicted graft survival (P < 0.05). According to Kaplan-Meier survival curves, graft survival rates at 6 months, 2 years, and 5 years in the futility group dramatically decreased to 50% compared to the other groups (log-rank 8.806, P < 0.05). The EAD Olthoff and MEAF scores did not demonstrate predictive capacity for recipient or graft survival. Based on Kaplan-Meier survival curves, patients with a MEAF score ≥ 7 had a lower graft survival rate at 6 months, 2 years, and 5 years compared to patients with a lower MEAF score (log-rank 4.667, P < 0.05).
CONCLUSION
In our series, both UK DCD risk score and MEAF score showed predictive capability for graft survival.
Core Tip: Controlled donation after circulatory death (DCD) grafts are increasingly being used in liver transplantation, and in some countries, more than one‐third of the deceased donor liver transplants are performed with DCD grafts. Nonetheless, DCD grafts are not risk-free. Despite the increased complexity in predicting outcomes for liver transplant recipients from DCD, risk scores for allograft failure remain a valuable tool in assisting clinicians in identifying patients at higher risk for adverse outcomes and guiding decision-making in post-transplant care.
