Combination of extended donor criteria and changes in the model for end-stage liver disease score predict patient survival and primary dysfunction in liver transplantation: A retrospective analysis

Background. The purpose of this study was to analyze the impact of extended donor criteria (EDC) and of changes in the Model for End-Stage Liver Disease (MELD) score while waiting for liver-transplantation (Delta-MELD) on patient survival and initial graft function. Methods. We included 386 consecutive patients with end-stage liver disease who underwent orthotopic liver transplantation at the Medical University Vienna between 1997 and 2003. Primary outcome was patient survival and secondary outcome was initial graft function. EDC included: age > 60 years, > 4 days intensive medical care, cold ischemia time > 10 hr, need for noradrenalin > 0.2 mu g/kg/min or doputamin > 6 mu g/kg/min, a donor peak serum sodium > 155 mEq/L, a donor serum creatinine > 1.2 mg/100 mL, and a body mass index > 30. Results. Delta-MELD was significantly higher in the nonsurvivor population (P=0.01) and EDC showed a significant influence on initial graft function (P=0.01). Worsening in either Delta-MELD or the presence of at least two EDC was not associated with an increased risk of primary graft dysfunction and death. Worsening in Delta-MELD and the presence of at least two EDC was significantly associated with primary graft dysfunction (P=0.01) and death (P=0.008). Conclusion. The combination of a liver recipient with worsening Delta-MELD and a potential donor with at least two EDC should be avoided.