The objective of the study was to investigate the evolution and trends in liver donation in the city of Moscow, with special focus on the expansion of liver donor selection criteria for transplantation.Materials and methods. The study included 1,548 effective donors (EDs) in the period from January 1, 2012 to December 31, 2020. Their basic characteristics - age and cause of death - are presented. The dynamics of changes in the age groups of donors and the dynamics of the number of >60-year-old liver donors were studied. The influence of expanded liver donor selection criteria over the dynamics of the number of transplant surgeries and patient flow on the waiting list was assessed.Results. During the study period, the number of effective liver donors (ELDs) in Moscow increased 4.7-fold. The average age of ELDs increased from 37.1 in 2012 to 48.8 in 2020. There was an absolute prevalence of donors who died from cerebrovascular accident compared with donors who died from traumatic causes, 83.4% vs 16.6%, respectively. Since 2016, there has been a progressive increase in >60-year-old liver donors; the number of such donors in 2020 reached 39, accounting for 13.6% of the total pool of EDs. The progressive growth in the number of liver transplants has significantly influenced patient movement on the waiting list. In 2012, there was a 25.2% increase in the number of liver transplants per 100 patients on the waiting list; by 2020, it had reached 86.6%.Conclusion. The results reasonably indicate an increase in liver donation and liver transplantation (LTx) in Moscow. Comparison of Russian data with those of leading foreign donor programs shows that the trends in the donor pool in the context of older age, including >60-year-old donors, and shifting causes of donor death towards cerebrovascular diseases are similar. An overall increase in donor activity and expansion of liver donor criteria contributed to an increase in the number of transplants performed per 100 patients on the waiting list, which, in turn, reduced the waiting time for a donor organ and increased the intensity of patient flow on the waiting list.

Aim. To study the frequency of fatty hepatosis in liver biopsies of consecutive brain death donors before cold preservation. Materials and methods. Liver biopsies (before cold preservation) of 300 consecutive donors with brain death were studied. Histological preparations were stained with hematoxylin and eosin, and tricolor Masson staining was performed. Results. The frequency of different degrees of fat hepatosis in men and women did not differ significantly (>0.05). Fat dystrophy of hepatocytes was absent in more than half of the cases (n = 182; 60.7%). A slight degree of fatty degeneration was diagnosed in 57 (19,0%) donors. In total, 239 (79.7%) donor livers were absolutely suitable for transplantation. Moderate degree of steatosis, which is associated with early biliary complications, was detected in 18 (6.0%) cases, and severe degree, which is a contraindication to the use of the organ for transplantation, was detected in 43 (14.3%) cases. Conclusion. Before cold preservation, liver from brain death donors is relatively rarely unsuitable for transplantation.

Objective: to study the differences in the frequency of pathological processes in liver biopsy samples of donors older than 60 years (group 1) and donors currently recognized as “standard” by age – 60 years and younger (group 2). Material and methods. Of the total pool of 300 consecutive donors with brain death, there were 28 (9.3%) donors over 60 years old (61 to 73 years old; 19 men and 9 women). Results. The frequency of pathology is independent of gender in both groups (p > 0.05). In elderly donors, compared with “standard” donors, mild (p < 0.05) and significantly more often severe (p < 0.05) albuminous degeneration are significantly less frequent, and there is only a tendency (p > 0.05) to more frequent mild hepatic steatosis. Dystrophic processes are the result of more severe ischemic injury to the liver of elderly donors. Ischemic liver injury determines the risk of more frequent biliary complications, which require careful monitoring and maintenance at an optimal level of hemodynamics for donors in the intensive care unit. Based on other morphological parameters, the liver of donors above 60 years of age does not significantly differ (p > 0.05) from the liver of donors 60 years and younger. Conclusion. To expand the donor pool, age restrictions should be removed when selecting a liver for transplantation, thereby maximizing the use of donor potential.