Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors

Balázs Nemes, György Gámán, Wojciech G. Polak, Fanni Gelley, Takanobu Hara, Shinichiro Ono, Zhassulan Baimakhanov, Laszlo Piros, Susumu Eguchi

Research output: Contribution to journalReview article

24 Citations (Scopus)

Abstract

The definition and factors of extended criteria donors have already been set; however, details of the various opinions still differ in many respects. In this review, we summarize the impact of these factors and their clinical relevance. Elderly livers must not be allocated for hepatitis C virus (HCV) positives, or patients with acute liver failure. In cases of markedly increased serum transaminases, donor hemodynamics is an essential consideration. A prolonged hypotension of the donor does not always lead to an increase in post-transplantation graft loss if post-OLT care is proper. Hypernatremia of less than 160 mEq/L is not an absolute contraindication to accept a liver graft per se. The presence of steatosis is an independent and determinant risk factor for the outcome. The gold standard of the diagnosis is the biopsy. This is recommended in all doubtful cases. The use of HCV+ grafts for HCV+ recipients is comparable in outcome. The leading risk factor for HCV recurrence is the actual RNA positivity of the donor. The presence of a proper anti-HBs level seems to protect from de novo HBV infection. A favourable outcome can be expected if a donation after cardiac death liver is transplanted in a favourable condition, meaning, a warm ischemia time < 30 minutes, cold ischemia time < 8–10 hours, and donor age 50–60 years. The pathway of organ quality assessment is to obtain the most relevant information (e.g. biopsy), consider the co-existing donor risk factors and the reserve capacity of the recipient, and avoid further technical issues.

Original languageEnglish
Pages (from-to)827-839
Number of pages13
JournalExpert Review of Gastroenterology and Hepatology
Volume10
Issue number7
DOIs
Publication statusPublished - Jul 2 2016

Keywords

  • HCV
  • Liver transplantation
  • biliary complications
  • donor
  • extended criteria
  • hepatitis C
  • machine perfusion
  • recurrence
  • steatosis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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