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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. - PowerPoint PPT Presentation
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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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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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