Evaluation of Liver Transplantation Outcomes Using Grafts From Brain-Dead Donors With Warfarin-Associated Coagulopathy.

Abstract

Background: Liver transplantation is the definitive therapy for end-stage liver disease. The severe organ shortage necessitates exploring grafts from extended-criteria donors, including those who become brain dead due to toxicological causes. This study evaluated the outcomes of liver transplantation using grafts from brain-dead donors with confirmed warfarin-associated coagulopathy (WAC).

Methods: This retrospective observational cohort study was conducted at a high-volume transplant center (1994-2024). Ten recipients who received liver grafts from brain-dead donors with WAC were included. Clinical data were reviewed to assess liver function recovery, complications, and survival.

Results: The cohort included 10 recipients (8 males, 2 females; mean age: 49.8 ± 13.2 years). Liver function tests and international normalized ratio (INR) levels showed significant improvement by Postoperative day 7. Acute rejection occurred in two recipients (20%), successfully treated with corticosteroids. One patient (10%) developed primary nonfunction, leading to death. Patient survival was 100% at 30 days and 70% at 1 year; corresponding graft survival was 90% and 70%.

Conclusion: In this small, highly selected cohort, liver grafts from brain-dead donors with WAC may be used with acceptable short-term safety. These preliminary findings demonstrate feasibility and highlight the need for larger, controlled studies to further evaluate outcomes and donor selection criteria.