Feasibility of using a liver infected with Clonorchis sinensis for liver transplantation: Fourteen cases

Abstract

Use of livers infected with Clonorchis sinensis as donor organs for transplantation is controversial because of the potential associated risks. The low availability of donor livers at Tianjin First Center Hospital since 2003 prompted us to undertake cadaveric liver transplantation in 14 patients using donor livers infected with C. sinensis. None of the donors had been diagnosed with liver fluke infection before organ procurement, and in none of them was there laboratory evidence of abnormal liver function. After livers had been harvested and preserved, dead liver flukes were found in the bile of each donor; subsequent pathological examination of the flukes confirmed the diagnosis of clonorchiasis. Conventional orthotopic liver transplantation, with insertion of a T-tube, was undertaken in all 14 patients. Praziquantel, 25 mg/kg three times daily for two days, was administrated to the recipients starting on postoperative day 2. Results of tests of liver function improved rapidly after the operation in all of the patients. The median duration of follow-up was 31 months. The 1-and 3-year survival rates of the grafts were 85.7% and 78.6%, respectively. Postoperative biliary complications occurred in 2 patients (14.3%). No ova were detected in the bile or feces of any of the patients postoperatively. These findings suggest that livers infested with C. sinensis can be used as donor organs for liver transplantation. Further studies are required to establish definitive criteria for determining whether such donor organs may be used in a liver transplantation program.

Liver fluke‐infested graft used for living‐donor liver transplantation: case report and review of the literature

“…To date, only 20 cases of transplanted liver grafts infested with C. sinensis (Table ) and 7 with S. mansoni have been reported in the literature . All the liver transplantations with grafts infested with C. sinensis (18 in adult and 2 in pediatric recipients) were performed in East Asian countries, 16 of which were deceased‐donor living transplantation and 5 LDLT.…”

“…The 14 cases reported by Zhu et al had the longest follow‐up until now, with a median of 31 months. No definite liver fluke‐related late complication was observed in any treated patient with a follow‐up of approximately 1 year, and both the donors and the recipients were safe and without any other sign of C. sinensis infestation at stool examination.…”

“…It was also speculated that adult liver flukes do not survive low‐temperature perfusion and cold preservation of the liver . However, this does not prevent possible complications, such as the occlusion of biliary stents or bile duct by dead parasites, as reported by Yeung et al and She et al .…”

“…Infested hosts may remain asymptomatic for decades and consequently their liver can become available as a graft. Twenty liver transplantations with C. sinensis-infested grafts are reported in the literature (3)(4)(5)(6)(7)(8)(9). All of them occurred in Asian countries.…”

Not just a fluke: Expanding the organ supply

“…A better understanding of the risks of certain infections can expand the organ donor pool and increase the safety of transplantation with these organs. In endemic regions, certain infections are more likely to pose a risk of transmission from the donor to the recipient; examples include histoplasmosis in Africa and the Americas, Leishmania species in regions of the Old World and New World, Trypanosoma cruzi in the Americas, Coccidioides in the southwest of North America, and the liver fluke ( Clonorchis sinensis ) in Asia, as reported in this issue of Liver Transplantation by Zhu et al1 Although it is easy to refuse these organs, such a conservative refusal results in an excessive loss of organs and a significant loss of life among organ transplant recipients on the waiting list. Further consideration is needed to safely turn a potential refusal into an optimal and safe situation.…”