Liver transplantation: expanding the donor pool

Rossi, Massimo; Simone, P De; Peritore, D.; Iappelli, M; Pretagostini, R.; Lonardo, Maria Teresa; Cancrini, Caterina; Novelli, G.; Nudo, F.; Blasis, V De; Donadio, R; Berloco, P.B.; Cortesini, Raffaello

doi:10.1016/s0041-1345(00)02487-8

Cited by 12 publications

(7 citation statements)

References 8 publications

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“…Because of the severe donor liver shortage, there has been much effort in identifying ways to increase the donor pool, such as harvesting living donors and splitting donated livers 36. These approaches contribute approximately 10% of the total donor pool and, in the case of living donors, present major and potentially fatal risks for the donors.…”

Section: Discussionmentioning

confidence: 99%

Technique for expanding the donor liver pool: Heat shock preconditioning in a rat fatty liver model

et al. 2004

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Fatty liver is a common predisposing risk factor for postoperative liver failure and accounts for most discarded livers during triage of donors. We investigated the effect of heat shock preconditioning (HPc) on recipient survival in a rat fatty liver transplantation model. Fatty liver donor rats were exposed to brief whole-body hyperthermia (10 minutes at 42.5°C) and allowed to recover. HPc induced heat shock proteins (HSPs) (HSP72, HSP90, and heme oxygenase [HO]-1) in donor livers, with levels peaking 12 to 48 hours after HPc. Subsequently, donor livers were harvested 24 hours after HPc, placed in cold storage for 10 hours, and transplanted into normal rats. At 3 hours posttransplantation, HPc reduced serum liver enzymes in the recipients and almost completely suppressed the release of tumor necrosis factor (TNF)-␣ and interleukin (IL)-10. Histologic evaluation 3 and 24 hours after transplantation showed that HPc significantly reduced hepatic inflammation and hepatocellular necrosis without affecting the steatotic appearance of hepatocytes. One week after transplantation, control non-heat-shocked and heat-shocked fatty liver recipients exhibited survival rates of less than 10% and more than 80%, respectively. The evaluation of the survival of recipients receiving fatty livers at different times after HPc showed that the protective effect of HPc was significant when donor livers were transplanted 3 to 48 hours after HPc, with the maximum effect seen 6 to 48 hours after HPc. In conclusion, HPc is a promising avenue to salvage rejected donor fatty livers and enhance the survival rate of fatty liver recipients. We estimate that this technique could increase the annual donor pool by 600 livers. (Liver Transpl 2004;10:264 -272.)

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Section: Discussionmentioning

confidence: 99%

Technique for expanding the donor liver pool: Heat shock preconditioning in a rat fatty liver model

et al. 2004

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“…Recent studies have reported adequate function of livers with microvescicular steatosis. 37,38,45,46 Clinically, recipients who receive grafts with moderate steatosis (Ͼ25% to 30%) have impaired early graft function in the first 3 days as reflected by a higher peak serum glutamic oxaloacetic transaminase, lower bile output, and increased intraoperative bleeding. Marsman et al 47 transplanted 59 livers with up to 30% fat and compared them to time-matched controls; the fatty liver group had a decreased 4-month graft survival and a decreased 2-year patient survival.…”

Section: Steatotic Donorsmentioning

confidence: 99%

The utility of marginal donors in liver transplantation

Busuttil¹

2003

Liver Transplantation

630

508

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The shortage of organs has led centers to expand their criteria for the acceptance of marginal donors. The combination of multiple marginal factors seems to be additive on graft injury. In this review, the utility of various marginal donors in patients requiring liver transplantation will be described, including older donors, steatotic livers, non-heart-beating donors, donors with viral hepatitis, and donors with malignancies. The pathophysiology of the marginal donor will be discussed, along with strategies for minimizing the ischemia reperfusion injury experienced by these organs. Finally, new strategies for improving the function of the marginal/expanded donor liver will be reviewed. (Liver Transpl 2003;9:651-663.)

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“…In addition to these, hepatocellular carcinoma was present in the explanted livers of 38 patients (24%). The transplant team used extended criteria to determine donor eligibility [3,6]. Potential donor livers were rejected if the biopsy showed more than minimal fibrosis or inflammation, or if the donor was older than 50 years and the biopsy displayed more than 50% total steatosis.…”

Section: Case Materialsmentioning

confidence: 99%

“…On the other hand, the role of microvesicular steatosis remains unclear. Some studies have found livers with microsteatosis, regardless of its amounts, suitable for transplantation [5][6][7], whereas others have shown that such grafts are associated with higher rates of organ failure [8,9].…”

Section: Introductionmentioning

confidence: 99%