Quebec experience from 2003 to 2009 M Carrier MD, JF Lize MD and Quebec transplant programs

Impact of expanded criteria donors on patient survival after heart, lung, liver and combined organ transplantation

Quebec experience from 2003 to 2009

M Carrier MD, JF Lize MD and Quebec transplant programs

Introduction

• Expanded criteria donors (ECD) represent a large proportion of our total population of organ donors.

• The use of marginal or ECD has become a common clinical practice because of the gap between the number of candidate for transplantation and the number of donor available.

Objective

• Although ECD criteria were developed for kidney donors, these criteria are widely used to report donors characteristics in general.

• The objective of the present study is to compare outcomes of patients who underwent heart, lung, liver and combined organ transplantation with ECD and SCD in our patient population.

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Ensemble pour le don d'organes Transplant Québec 3

Methods

• Retrospective review of donors used for organ transplantation from 2003 to 2009.

• Analyses of patient survival with a clinical follow up until may 2010.

• Patient survival were studied with uni and multivariate methods in regard to the effect of donor and recipients characteristics.

SURVIVAL AFTER COMBINED ORGAN TRANSPLANTATION

• The analysis is difficult because of the small number of patients:

– Liver/kidney 17 patients– Heart/kidney 6 patients– Heart/liver 4 patients

• Patient survival averaged 75%±9% in SCD and 67%±19% ECD recipients 2 years after transplantation.

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Discussion

• Liver and lung donors have specific criteria that are predictive of a higher risk at transplantation. The actual classification of ECD is not predictive of poor outcomes.

• Although the number of patients in the present study is not sufficient, ECD criteria could be a risk factor for survival after heart and combined organ transplantation.

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Conclusion

• The current definition of SCD and ECD had no effect on patient survival after lung and liver transplantation. There was a trend towards decreased patient survival in heart and combined organ transplant recipients from ECD.

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Thanks to all co-autors and collaborators:

University of Montréal: Dr A. Roy, Dr M. Bilodeau, Dr P. PoirierMcGill Univeristy: Dr M. Cantarovich, Dr P. ChaudhuryLaval University: DR B. Cantin

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Identification of New Donor Variables Associated With Graft Survival in a Single-Center Liver Transplant CohortO.Nafidi, Denis Marleau, Andre Roy, Marc BilodeauCentre hospitalier de l’Universite de MontrealLIVER TRANSPLANTATION 16:1393-1399, 2010

• Prevalence of Marginal Donors

• Age >60 years, BMI 35 kg/m2

• Donor cause of death: anoxia or CVA

• Organ obtained outside the local program

• Donor AST or ALT >500 U/L

• Donor total bilirubin >2.0 mg/dL

• HCV antibody positivity HBV core antibody positivity

• Donation after cardiac arrest

• Cold ischemia time >12 hours

• Macrosteatosis exceeding 30%

• History of alcohol dependency within 6 months of donation

• History of malignancy other than basal or squamous cell skin cancer

• History of cocaine use within 6 months of donation

• History of diabetes mellitus

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Independent variables predicting one year graft survival

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Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation Eric S. Weiss et al.The Journal of Heart Lung Transplantation 2011

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Quebec experience from 2003 to 2009 M Carrier MD, JF Lize MD and Quebec transplant programs

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