The utility of marginal donors in liver transplantation

Abstract

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.)

Addition of simvastatin to cold storage solution prevents endothelial dysfunction in explanted rat livers

“…Second, it is well known that cold-storage and warm-reperfusion injuries are especially severe, and are associated with serious morbidity and mortality when using expanded criteria donors or marginal ones. 2 The new approach for better preservation of organs for transplantation described in the present study opens the possibility to improve the function of liver grafts from marginal donors by using vasoprotective preservation solutions, which would represent a main step forward to improve donor pools and overcome current problems of organ shortage.…”

“…However, marginal livers are much more prone to primary graft failure after transplantation. 2 Hepatic ischemia/reperfusion (I/ R) injury is considered one of the main determinants of the outcome after liver transplantation. 3,4 The process of hepatic I/R injury is a sequence of events involving many interconnected factors occurring in a variety of cell types.…”

Liver transplantation in Indian Armed Forces—initial experience

“…4 It is important to plan the use of these liver grafts judiciously to obtain the best results. Around 19 of the 34 livers (55.8%) were harvested from marginal or extended criteria donors (Table 1).…”

“…Ensuring integrity of the blood supply to the biliary tree, transecting the bile ducts along with the hilar plate and refinement in techniques of biliary anastomosis in LDLT has resulted in a significant reduction in the incidence of biliary complications from 24.3-40.6% before 2007 to 5. [3][4][5][6][7][8][9][10][11][12].8% in studies published after 2008 (Table 6). [27][28][29][30][31][32][33][34] Overall biliary complications in LDLT in our series was seen in three recipients (16.6%) which compares well with other studies.…”

O doador marginal: experiência de um centro de transplante de fígado

“…A lesão de isquemia e reperfusão é responsável pela disfunção primária do enxerto e pela sua apresentação mais grave, a falência primária. A escassez de órgãos para transplante obrigou a utilização de enxertos classificados como sub-ótimos, nos quais existe grande suscetibilidade para a lesão de isquemia e reperfusão 18,19,20 . Entretanto persiste relação incerta entre a qualidade desses órgãos e a expectativa de vida nos receptores de transplante com órgãos marginais.…”