In-situ vs Ex-situ Liver Preservation

QALYs derived from EQ-5D-5L questionnaire measured at six time points: waitlist registration, and at six weeks, three, six, twelve and twenty-four months post-transplantation. If aNRP is estimated to lead to higher costs as well as better health outcomes or to lower costs and worse health outcomes, an incremental cost-effectiveness ratio (ICER) will be calculated (costs per QALY gained or savings per QALY lost). If not, one treatment will be considered dominant. As aNRP perfuses multiple organs at once, the overall costs per procedure and subsequent transplantations will be researched.

Narrowing or irregularity of intra- or extra-hepatic donor bile duct excluding the biliary anastomosis leading to clinical symptoms or laboratory derangements in the absence of hepatic artery thrombosis for which an invasive intervention is required.

Health-Related Quality of Life via PROMIS questionnaire: Patient-Reported Outcomes Measurement Information System, that assesses seven core health domains using 4-item short form items plus one pain intensity item (scale 0-10, with 10 worse outcome).

Recipient death

Failure of the liver allograft requiring either re-transplantation or leading to recipient mortality.

Also including vascular complications (hepatic artery and portal vein thrombosis)

And complications graded as Clavien Dindo => 3a, and the comprehensive complication index

In days

Environmental Demand: Measured in global hectares (gha). Converts all physical inputs (Greenhouse Gas Emissions: Measured in kg CO₂e, Electricity: Measured in kWh an Consumables \& Waste: Measured in kg of waste and liters (L) of fluids) into the total biophysical land area required to support each distinct protocol.

How many livers are transplanted and still functioning from organ offer to 1 year post transplantation. It takes in account the acceptance rate, discard rate, transplant rate and 1-year survival.

Clinically significant bleeding event requiring percutaneous or surgical re-intervention

A drop in mean arterial pression ≥30% from the baseline for at least 1 min and within 5 min from reperfusion

Any extracorporeal therapy to supplement or replace renal function that was not present before transplant

e.g. MRCP, ERCP and percutaneous transhepatic cholangiography drainage

Number of reoperations

EASE = -0.602 + 0.044*(MELD at transplant) + 0.065*(number of PACKED RED BLOOD CELL transfused units during surgery) + 2.567 (if arterial or portal thrombosis during days 1-10) + 0.000534*(AUC ln AST in POD1,2,3,7,10)2 - 0.093*(AUC ln PLT in POD1,3,7,10) - 7.766*(slope ln PLT in POD1,3,7,10) + 0.795*(slope ln billirubin in POD1,3,7,10) - 0.402 (if center volume ≥70 cases per year).

Five EASE risk groups for graft and patient survival were defined as follows: (1) risk group 1: EASE score < -3.43; (2) risk group 2: -3.43 ≤ EASE score ≤ -1.26; (3) risk group 3: -1.25 ≤ EASE score ≤ -0.75; (4) risk group 4: -0.74 ≤ EASE score ≤ -0.01 (5) risk group 5: 0 ≤ EASE score ≤ 5. Risk group 5 is the worse outcome.

Failure of the liver allograft requiring explant and replacement with an alternative liver graft

Graft loss, re-transplantation, or patient death within 14 days of initial transplantation not secondary to hepatic artery thrombosis, biliary complication, recurrent disease or acute rejection.

Localized narrowing of the biliary anastomosis between the donor and recipient bile ducts for which an invasive intervention is required.

Extra-luminal escape of biliary contents that requires invasive intervention (percutaneous or surgical)

Enzymatic changes related to slow-resolving recipient liver disease that resolves without treatment should not be graded as a complication.

Enzymatic changes related to an initially impaired graft function leading to more frequent observation (ie, laboratory tests, repeat ultrasound). Officially diagnosed if a patient meets at least one of the following lab conditions: AST or ALT > 2000 IU/L within the first 7 postoperative days, total bilirubin >= 10 mg/dL on postoperative day 7. International normalized ratio (INR) +. 1.6 on postoperative day 7.

the probability that a transplanted organ is still functioning exactly one year after the procedure, excluding patients who died with a working organ from the failure count

the probability that a transplanted organ is still functioning exactly one year after the procedure

all-cause mortality within 365 days post-transplantation

For assessing personnel sustainability. Team members include retrieving surgeons, organ perfusionists, organ donation coordinators, organ transplantation coordinators, transplant surgeons, scrub nurses during retrieval and transplantation, anesthesiologists, anesthetics nurse, drivers.

Number of readmissions

before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in µmol/L.

before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in mmol/L.

In short: ALP. Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in U/L.

In short: ALT. Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in U/L.

In short: GGT. Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in U/L.

Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in µmol/L.

In short: AST. Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in U/L.

In short: INR. Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years.

Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured /L.

Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in mmol/L.

Measured before LTx, post-LTx days 1-7 and 10, 6 months, 1, 3 and 5 years. Measured in mL/min/1.73m²

Number of organs transplanted per donor