Outcomes of liver transplantation using extended criteria brain-dead donors: a retrospective study with initial experiences from a Vietnamese center

Background: The persistent scarcity of deceased donor organs continues to limit liver transplantation (LT) worldwide. Extended criteria donors (ECD) represent a practical strategy to expand the donor pool; however, concerns remain regarding graft dysfunction and early mortality. This study aimed to evaluate clinical outcomes of LT using ECD grafts at Viet Duc University Hospital (2012-2023). Methods: A retrospective descriptive study was conducted using convenience sampling. All recipients who received ECD grafts were included and compared with recipients of standard criteria donor (SCD) grafts. Primary outcomes included early (≤90 days) and late (>3 months) postoperative complications, intensive care unit (ICU) and hospital length of stay, 90-day mortality, and overall survival (OS). Results: Of 65 LTs, 25 (38.5%) used ECD grafts. The most frequent ECD criterion was severe hypernatremia (>170 mmol/L; 36%). Recipients were predominantly male (93.8%), mean age of 52.1 years, mostly indicated for hepatocellular carcinoma on a background of hepatitis B infection (>80%). ICU stay (4.7 vs. 5.2 days, P=0.35), hospital stay (27.2 vs. 27.0 days, P=0.91), and overall complication rates did not differ significantly between groups. Early ECD complications included rejection (4%) and primary graft dysfunction (4%). Although 90-day mortality was higher in the ECD group (8% vs. 2.5%), it was not statistically significant. Long-term outcomes were comparable: 5- and 10-year OS rates were 83.1% and 66.5% in the ECD group versus 71.9% and 71.9% in the SCD group (P>0.05). Conclusions: LT using ECD grafts provides comparable short- and mid-term survival to SCD grafts, despite a slightly increased risk of early severe complications.