title: Brain death and marginal grafts in liver transplantation.
abstract: It is well known that most organs for transplantation are currently procured from brain-dead donors; however, the presence of brain death is an important risk factor in liver transplantation. In addition, one of the mechanisms to avoid the shortage of liver grafts for transplant is the use of marginal livers, which may show higher risk of primary non-function or initial poor function. To our knowledge, very few reviews have focused in the field of liver transplantation using brain-dead donors; moreover, reviews that focused on both brain death and marginal grafts in liver transplantation, both being key risk factors in clinical practice, have not been published elsewhere. The present review aims to describe the recent findings and the state-of-the-art knowledge regarding the pathophysiological changes occurring during brain death, their effects on marginal liver grafts and summarize the more controversial topics of this pathology. We also review the therapeutic strategies designed to date to reduce the detrimental effects of brain death in both marginal and optimal livers, attempting to explain why such strategies have not solved the clinical problem of liver transplantation.
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Esther Koplowitz Center, Barcelona, Spain.
authors.forename: M B
authors.initials: MB
authors.lastname: Jiménez-Castro
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, IDIBAPS, CIBEREHD, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gracia-Sancho
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Esther Koplowitz Center, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Peralta
mesh_terms: D001926:Brain Death / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement