Selection criteria for liver transplant donors.
As the number of successful liver transplants has increased, the demand for donors has outpaced the supply. Approximately 25% of patients die awaiting an appropriate donor. Current criteria for assessing potential donors need to be closely examined. Fifty-six potential donors were evaluated by our transplant team by utilizing standard liver function tests (LFT's)-SGOT, SGPT, bilirubin. Additionally, a lidocaine metabolism test was performed by giving a 1 mg/kg IV dose of lidocaine over 1 minute and measuring the accumulation of the major metabolite monoethylglycinxylidide (MEGX) at 15 minutes by fluorescent polarization immunoassay (Abbott Diagnostics, Abbott Park, IL). Previous work has suggested that a MEGX less than 50 ng/mL is associated with initial non-function. Thirty-four donors were transplanted (group I) and all had initial function (all MEGX values were greater than 50). Twenty-two donors (39%) were judged unacceptable (group II) by our transplant team and by outside centers based upon one of the following criteria: II A) elevated LFT's--8, 11 B) donor age--5, II C) donor instability--4, II D) no available recipient--3, II E) miscellaneous--2. Standard LFT's were not statistically different in the donors used and in those not used when excluding category II A. Six of seven donors excluded in group I had acceptable MEGX values indicating they may have been transplantable. Ten of 12 patients excluded in groups II B-D had normal LFT's and nine of 12 had acceptable MEGX values indicating they may have been transplantable also. In this era of organ shortage, a reevaluation of donor selection criteria utilizing new tests like MEGX may be necessary to meet the increased need.
Schroeder
T J
TJ
University of Cincinnati Medical Center, Department of Pathology, Ohio 45267-0714.
Pesce
A J
AJ
Ryckman
F C
FC
Tressler
T P
TP
Brunson
M E
ME
Pedersen
S H
SH
Tchervenkov
J I
JI
Penn
I
I
Alexander
J W
JW
Balistreri
W F
WF
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D016231:Fluorescence Polarization Immunoassay; D006801:Humans; D007223:Infant; D008012:Lidocaine / Q000031:analogs & derivatives / Q000097:blood / Q000378:metabolism; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
D008012:Lidocaine; C001173:monoethylglycinexylidide