Donor pool expansion in liver transplantation.
BACKGROUND
The shortage of donors has made it necessary to consider older subjects, those with mild or moderate steatosis, and those who are HBcAb- or hepatitis C virus (HCV)-positive as marginal donors.


METHODS
From April 1986 to January 2002, 690 orthotopic liver transplantations (OLTs) were performed in 603 patients. In this series we used 68 donors older than 70 years, 51 with steatosis (38 mild, 12 moderate, and 1 severe), 44 were HBcAb-positive and 6 were HCV-positive.


RESULTS
Of 68 grafts from donors older than 70 years, 65 were used as a first OLT. These grafts showed 3 PNF, 11 arterial complications, 12 re-OLTs, and 14 deaths with graft survival of 72.3% and 61.34% at 1 and 3 years, respectively. All patients who received the other 3 grafts, which were used for re-OLT, died between postoperative day 21 and 720. Among the 51 grafts with steatosis, we observed 2 PNF of those within the mild steatosis group and graft survival rates of 76.8% and 70.9% at 1 and 3 years, respectively. Forty-four grafts from HBcAb-positive subjects were used in 18 HBsAg-negative and 26 HBsAg-positive recipients. Among the untreated patient group, 1 patient demonstrated hepatitis B virus (HBV) reinfection and 1 patient had de-novo HBV. No reinfection or de novo infections were observed in the 13 patients treated with immunoglobulin or in the 19 patients treated with lamivudine plus immunoglobulin, or in the only patient treated with lamivudine. Graft survival rates were 64.1% and 54.7% at 1 and 3 years, respectively. Among who received 6 patients transplants from HCV-positive donors, we observed 1 recurrence of chronic hepatitis, 1 re-OLT for hepatic vein stenosis, and 1 PNF.


CONCLUSIONS
Old donors, those with moderate steatosis, or those who are HBcAb- and HCV-positive can be safely used in selected recipients to reduce waiting list mortality.
Montalti
R
R
Department of Surgery, ICU and Transplantation, University of Bologna, Bologna, Italy. rmontalti@hotmail.com
Nardo
B
B
Bertelli
R
R
Beltempo
P
P
Puviani
L
L
Vivarelli
M
M
Cavallari
A
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D002102:Cadaver; D002423:Cause of Death; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006509:Hepatitis B / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000032:analysis; D006526:Hepatitis C / Q000635:transmission; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors / Q000145:classification* / Q000706:statistics & numerical data
D006510:Hepatitis B Antibodies