Donor characteristics associated with liver graft survival.

BACKGROUND

Organ availability is affecting the development of liver transplantation in its entirety, leading to transplant teams expanding the criteria for accepting organ donors. In these circumstances, analysis of the impact of the donor's characteristics on graft survival becomes mandatory.

METHODS

Fifty-two donor variables from 5,150 liver transplants performed in Spain between 1994 and 2001 were analyzed through a univariate analysis. Those with statistically significant impact on graft survival were entered in a Cox regression model with the recipients' characteristics and other factors linked to the graft technique.

RESULTS

Several donor factors negatively affect graft survival: donor age, cause of death, body mass index, vasoactive drug administration, prolonged intensive care unit (ICU) stay, increased alkaline phosphatase and liver enzyme levels, low bicarbonate level, and antecedents of hypertension. However, only four can be mentioned as representing a risk for losing the graft when donor variables are controlled with recipient or technique variables in a Cox regression model: donor age, antecedents of hypertension, prolonged ICU stay, and low bicarbonate level. In the same analysis, norepinephrine administration has a relative risk less than 1.

CONCLUSIONS

The multivariate analysis of the impact of 52 donor characteristics on liver graft survival showed the negative effect of an elderly donor, with hypertension combined with the presence of metabolic acidosis, or a prolonged ICU donor stay. The administration of norepinephrine alone during donor management showed a protective effect.