Effect Of Donor Transaminase Levels On Graft Survival Following Liver Transplant: An Analysis Of The Organ Procurement And Transplantation Network Database

Objectives: Despite data showing equivalent outcomes between grafts from marginal versus standard criteria deceased liver donors, elevated donor transaminases constitute a frequent reason to decline potential livers. We assessed the effect of donor transaminase levels and other characteristics on graft survival.Materials and Methods: We performed a retrospective cohort analysis of adult first deceased donor liver transplant recipients with available transaminase levels registered in the Organ Procurement and Transplantation Network database (2008-2018). We used Cox proportional hazards regression to determine the effects of donor characteristics on graft survival.Results: Of 53 913 liver transplants, 52 158 were allografts from donors with low transaminases (<= 500 U/L; group A) and 1755 were from donors with elevated transaminases (> 500 U/L; group B). Group A recipients were more likely to be hospitalized (P =.01) or in intensive care ( P <.001) or to have mechanical assistance (P <.001), portal vein thrombosis (P =.01), diabetes mellitus (P =.003), or dialysis the week before liver transplant (P =.004). Multivariable analysis (controlling for recipient characteristics) showed donor risk factors of graft failure included diabetes mellitus (P <.001), donation after cardiac death (P <.001), total bilirubin > 3.5 mg/dL (P <.001), serum creatinine > 1.5 mg/dL (P =.01), and cold ischemia time > 6 hours (P <.001). Regional organ sharing showed lower risk of graft failure (P =.02). Donor transaminases > 500 U/L were not associated with graft failure (relative risk, 1.02; 95% CI, 0.91-1.14; P =.74).Conclusions: Donor transaminases > 500 U/L should not preclude the use of liver grafts. Instead, donor total bilirubin > 3.5 mg/dL and serum creatinine > 1.5 mg/dL appear to be associated with higher likelihood of graft failure after liver transplant.