title: Liver transplantation using donor organs with markedly elevated liver enzymes: how far can we go?
abstract: BACKGROUND
  The disparity between the demand for solid organs and the current supply is a growing problem for patients with end-stage liver disease. To overcome organ shortage, extended criteria donor organs are also accepted for liver transplantation.
  
  
  OBJECTIVE
  We here unprecedentedly report the clinical course of patients receiving livers with markedly elevated liver enzymes.
  
  
  METHODS
  Between November 2007 and December 2010, 15 donor livers with markedly elevated liver enzymes [median aspartate aminotransferase (AST) 1400 (500-7538) U/l, median alanine aminotransferase (ALT) 1026 (308-9179) U/l] were offered to our transplant centre. Based on elaborate judgment, seven of these donor livers were rejected and eight donor livers were transplanted.
  
  
  RESULTS
  All eight transplanted patients showed a liver enzyme peak on the day of surgery (AST 2076 ± 1808 U/l, ALT 1087 ± 833 U/l) and a statistically significant decrease from day 0 to day 7 post-liver transplantation. INR decreased and platelet count increased statistically significantly within 1 week after liver transplantation. The patients were discharged from the hospital 28 ± 11 days after liver transplantation in good clinical condition.
  
  
  CONCLUSIONS
  These data demonstrate that using donor livers with markedly elevated liver enzymes may be an acceptable option to expand the donor pool. Universal objective parameters for acceptance should be defined in future studies.
authors: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. sonia.radunz@uk-essen.de
authors: Sonia
authors: S
authors: Radunz
authors: Andreas
authors: A
authors: Paul
authors: Knut
authors: K
authors: Nowak
authors: Jürgen W
authors: JW
authors: Treckmann
authors: Fuat H
authors: FH
authors: Saner
authors: Zoltan
authors: Z
authors: Mathé
mesh_terms: D000410:Alanine Transaminase / Q000378:metabolism*; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D058625:End Stage Liver Disease / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000201:enzymology*; D016031:Liver Transplantation / Q000379:methods* / Q000592:standards; D014019:Tissue Donors / Q000600:supply & distribution*; D019737:Transplants / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase