Extended Criteria Donors in Liver Transplantation: Adapting Donor Quality and Recipient

• Published in: Transplantation proceedings Vol. 41; no. 3; pp. 975 - 979
• Main Author: Gastaca, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.04.2009; Elsevier
• Subjects: Age Factors; Biological and medical sciences; Fatty Liver - epidemiology; Fatty Liver - surgery; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Liver Transplantation - mortality; Liver Transplantation - physiology; Liver Transplantation - statistics & numerical data; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Middle Aged; Patient Selection; Registries; Spain; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Survivors; Tissue Donors - statistics & numerical data; Tissue, organ and graft immunology; Treatment Failure; Treatment Outcome; Spain; Suboptimal donor; Human; Digestive system; Liver; Recipient; Homotransplantation; Medicine; Treatment; Criterion; Surgery; Quality; Graft; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.02.016

Abstract Despite the progressive increase in the number of liver transplantations, the mortality on the waiting list remains between 5% and 10%, and patients have to deal with longer waiting periods. Facing this situation, transplant centers have developed alternatives to increase the number of grafts by accepting donors who were previously considered to be inadequate, because they are at higher risk of initial poor function and graft failure or may cause disease transmission. Currently, some marginal donors are being routinely used: elderly donors, steatotic grafts, non–heart-beating donors, hepatitis C virus-positive (HCV+) or hepatitis B core antibody-positive donors. These so-called marginal or extended-criteria donors were initially used in high-risk or urgent recipients; however, the number of marginal grafts has significantly increased, forcing the transplant community toward their more rationale use to maintain excellent results of liver transplantation. In this new scenario, the adequacy between donor and recipient may be paramount. Advanced donor age seems to be related to a greater graft failure rate in HCV+ recipients. Early survival seems to be significantly reduced when steatotic grafts are used in recipients with high Model for End-stage Liver Disease (MELD) scores. Moreover, a decreased survival has been observed among high-risk patients receiving organs from marginal donors. No benefit seems to exist when high-donor risk index grafts are transplanted into recipients with low MELD Scores. The recognition of various donor groups according to their quality and the need for good donor and recipient selection must lead us to define new policies for organ allocation of marginal grafts that may come into conflict with current policies of organ allocation according to the risk of death among patients awaiting a liver transplantation.