Proposal and validation of a liver graft discard score for liver transplantation from deceased donors: a multicenter Italian study - Scorecard - MDSpire

Proposal and validation of a liver graft discard score for liver transplantation from deceased donors: a multicenter Italian study

  • By

  • Quirino Lai

  • Davide Ghinolfi

  • Alfonso W. Avolio

  • Tommaso M. Manzia

  • Gianluca Mennini

  • Fabio Melandro

  • Francesco Frongillo

  • Marco Pellicciaro

  • Zoe Larghi Laureiro

  • Rebecca Aglietti

  • Antonio Franco

  • Claudia Quaranta

  • Giuseppe Tisone

  • Salvatore Agnes

  • Massimo Rossi

  • Paolo de Simone

  • March 11, 2022

  • 0 min

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Clinical Scorecard: Development and assessment of a liver graft discard scoring system for deceased donor liver transplantation: findings from a multicenter study in Italy

At a Glance

CategoryDetail
ConditionEnd-stage liver disease requiring liver transplantation
Key MechanismsPrediction of liver graft discard risk based on donor characteristics and pre-procurement data
Target PopulationDeceased donors after brain death (DBD) evaluated for liver graft donation
Care SettingLiver transplant centers and organ procurement organizations

Key Highlights

  • A novel scoring system was developed and validated to predict liver-related graft discard in DBD donors.
  • Liver-related discard causes included poor histology, abnormal liver function tests/imaging, poor macroscopic appearance, and poor perfusion.
  • The score was tested for prediction of biopsy features and graft loss at 3 months post-transplant.

Guideline-Based Recommendations

Diagnosis

  • Use clinical, laboratory, and imaging data pre-procurement to assess liver graft suitability.
  • Perform liver graft biopsy selectively based on surgical evaluation during procurement.

Management

  • Apply the liver graft discard score to guide safe graft selection and maximize transplant pool.
  • Consider liver-related discard reasons carefully to avoid fatal recipient outcomes.

Monitoring & Follow-up

  • Monitor graft function and survival post-transplant, with follow-up at 3 months to assess graft loss.
  • Track donor hemodynamic parameters such as hypotension and vasoactive-inotropic score during ICU stay.

Risks

  • Inappropriate graft selection may lead to early graft dysfunction or graft loss.
  • Discarding potentially usable grafts reduces transplant opportunities and increases waiting list mortality.

Patient & Prescribing Data

Recipients of liver grafts from deceased donors after brain death

Using the discard scoring system may improve graft selection, reduce discard rates, and optimize transplant outcomes.

Clinical Best Practices

  • Incorporate multivariable risk assessment models including donor age, BMI, hemodynamic stability, and histology findings.
  • Use competing-risk logistic regression models to differentiate liver-related from unrelated discard causes.
  • Validate scoring systems with internal bootstrap methods and external datasets to ensure predictive accuracy.

References

Original Source(s)

Proposal and validation of a liver graft discard score for liver transplantation from deceased donors: a multicenter Italian study

  • by Quirino Lai, Davide Ghinolfi, Alfonso W. Avolio, Tommaso M. Manzia, Gianluca Mennini, Fabio Melandro, Francesco Frongillo, Marco Pellicciaro, Zoe Larghi Laureiro, Rebecca Aglietti, Antonio Franco, Claudia Quaranta, Giuseppe Tisone, Salvatore Agnes, Massimo Rossi, Paolo de Simone

  • March 11, 2022

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