Regional Variation in Utilization and Outcomes of Liver Allografts From Donors With High Body Mass Index and Graft Macrosteatosis: A Role for Liver Biopsy
| Autor: | Justin Steggerda, Andrew S. Klein, Darren Malinoski, Irene K. Kim, Matthew B. Bloom |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Time Factors Databases Factual Biopsy Risk Assessment Gastroenterology Body Mass Index Donor Selection Predictive Value of Tests Risk Factors Internal medicine Prevalence medicine Humans Obesity Healthcare Disparities High body mass index Retrospective Studies Transplantation medicine.diagnostic_test business.industry Donor selection Graft Survival Allografts medicine.disease Tissue Donors United States Liver Transplantation Fatty Liver Treatment Outcome Liver biopsy business Body mass index Utilization rate |
| Zdroj: | Transplantation. 103:122-130 |
| ISSN: | 1534-6080 0041-1337 |
| DOI: | 10.1097/tp.0000000000002379 |
| Popis: | BACKGROUND Obesity, defined as a high body mass index (hBMI) of 30 kg/m or greater, is a growing epidemic worldwide and is associated with multiple comorbidities. High BMI individuals account for an increasing portion of potential liver donors. Here we evaluate trends in the utilization and outcomes of hBMI donors on a national and regional level and the potential role of liver biopsy in donor evaluation. METHODS United Network for Organ Sharing Standard Transplant Analysis and Research database was evaluated for deceased donor liver transplants between 2006 and 2016 across 11 Organ Procurement and Transplantation Network regions. High BMI donors were compared with lower BMI counterparts and evaluated for biopsy rates, utilization rates and allograft outcomes. Univariate and multivariable analyses were performed. RESULTS Seventy-seven thousand fifty potential donors were identified and 60 200 transplants were evaluated. Utilization rates for hBMI donors were 66.1% versus 78.1% for lower BMI donors (P < 0.001). Pretransplant biopsy was performed more frequently in hBMI donors (52.1% vs 33.1%, P < 0.001) and macrosteatosis of 30% or greater was identified more often (21.1% vs 12.2%, P < 0.001). Biopsy performance increased utilization rate of hBMI donors in 7 of 11 Organ Procurement and Transplantation Network regions. region 6 showed the highest rate of biopsy performance, high rate of hBMI donor utilization, and highest 5-year estimated graft survival rates of all regions. CONCLUSIONS High BMI donors have not previously been associated with worse graft survival in multivariable analyses; however, they are used much less frequently. Liver biopsy may increase the utilization rate of hBMI donors and improve donor selection. Further evaluation of regions with high rates of utilization and good outcomes is warranted. |
| Databáze: | OpenAIRE |
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