Experience Using Extended Criteria Donors in First 100 Cases of Deceased Donor Liver Transplantation in Japan

Because of the serious organ shortage in Japan, the use of extended criteria (EC) donors is inevitable to increase the number of deceased donors. However, the influence of this practice on recipient outcomes has not been clarified yet. We analyzed donor and recipient factors to determine whether those factors, especially from EC donors impacted early recipient outcomes. From February 1999 to January 2011, 100 deceased liver transplantations were performed in Japan, including 85 consecutive adult cases (age >= 18 years) who were studied to evaluate whether 6 recipient and 16 donor factors affected 3-month (90-day) recipient survival. Upon univariate analysis, Model for End-stage Liver Disease (MELD) score >= 25 (P = .018), donor age >= 55 years (P = .040), and cold ischemia time (CIT) >= 10 hours (P = .00013) significantly reduced 3-month survival. Multivariate analysis confirmed the independent contributions of, three adverse factors including MELD score >= 25 (P = .0133, odds ratio [OR] = 12.3, 95% confidence interval [CI] = 1.7-90.3), donor age >= 55 years (P = .013, OR = 14.0, 95% CI = 1.6-119.5), and CIT >= 10 hours (P = .0024, OR = 67.6, 95% CI = 4.5-1024.9). Three-month recipient survivals with 0, 1, 2, and 3 positive factors were 100% (n = 34), 94.4% (n = 36), 53.8% (n = 13), and 0% (n = 2), respectively (P < .0001). In conclusion, to improve recipient short-term survivals, minimizing CIT is the first priority. In the long-term, we must promote deceased donation to reduce recipient MELD scores by shortening the waiting time, and revise the allocation system to minimize CIT by giving priority to the local area.