Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.97612
Revised: July 17, 2024
Accepted: August 2, 2024
Published online: December 18, 2024
Processing time: 108 Days and 16.4 Hours
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.
To validate different graft and recipient survival scores in patients undergoing liver transplantation (LT) with DCD grafts.
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.
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).
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.