The utility of marginal donors in liver transplantation.
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.
Busuttil
Ronald W
RW
Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Transplant Center, Los Angeles, CA 90095, USA. RBusuttil@mednet.ucla.edu
Tanaka
Koichi
K
D005234:Fatty Liver / Q000150:complications / Q000601:surgery; D006085:Graft Survival; D006323:Heart Arrest / Q000150:complications / Q000601:surgery; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation / Q000592:standards*; D009369:Neoplasms / Q000150:complications / Q000601:surgery; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D015427:Reperfusion Injury / Q000517:prevention & control; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D019737:Transplants / Q000592:standards*