title: Use of marginal grafts in deceased donor liver transplant: assessment of early outcomes.
abstract: BACKGROUND
  Orthotopic liver transplantation has become a routinely applied therapy for an expanding group of patients with end-stage liver disease. Shortage of organs has led centers to expand their criteria for the acceptance of marginal donors. There is current debate about the regulation and results of liver transplantation using marginal grafts.
  
  
  METHODS
  The study included data of all patients who received deceased donor liver grafts between March 2007 to December 2011. Patients with acute liver failure, living donor transplantation, split liver transplantation, and retransplantation were excluded. Early allograft dysfunction, primary nonfunction, patient survival, and incidence of surgical complications were measured.
  
  
  RESULTS
  A total of 33 patients were enrolled in this study. There were 20 marginal and 13 nonmarginal grafts. The two groups were well matched regarding age, sex and indication of liver transplantation, model for end-stage liver disease score, technique of transplant, requirement of vascular reconstruction, warm ischemia time, blood loss, mean operative time, etc. In our study, posttransplant peak level of liver enzymes, international normalization ratio, and bilirubin were not statistically significant in the marginal and nonmarginal group. Wound infection occurred in 10 % of marginal compared with 7.7 % of nonmarginal graft recipients (p > 0.05). In the marginal group, the incidences of vascular complications, hepatic artery thrombosis (four), and portal vein thrombosis (one) were not statistically significant compared to the nonmarginal group. Acute rejection was observed in a total of seven patients (21.2 %)-five (25 %) in the marginal group and two (15.4 %) in the nonmarginal graft recipients. Primary nonfunction occurred in three (9.1 %) patients-two (10 %) in the marginal and one (7.7 %) in the nonmarginal group. Average patient survival for the whole group was 91 % at 1 week, 87.8 % at 3 months, and 84.8 % at 6 months.
  
  
  CONCLUSIONS
  Because organ scarcity persists, additional pressure will build to use a greater proportion of the existing donor pool. The study, although small, clearly indicates that marginal livers can assure a normal early functional recovery after transplantation.
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Army Hospital (Research & Referral), Delhi, 110 010, India, drrajeshgodara@yahoo.co.uk.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Godara
authors.forename: C Sudeep
authors.initials: CS
authors.lastname: Naidu
authors.forename: Pankaj P
authors.initials: PP
authors.lastname: Rao
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.forename: Jayant K
authors.initials: JK
authors.lastname: Banerjee
authors.forename: Anupam
authors.initials: A
authors.lastname: Saha
authors.forename: Kapileshwer
authors.initials: K
authors.lastname: Vijay
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000502:physiology / Q000503:physiopathology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000209:etiology; D020127:Recovery of Function; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult