title: Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors.
abstract: The definition and factors of extended criteria donors have already been set; however, details of the various opinions still differ in many respects. In this review, we summarize the impact of these factors and their clinical relevance. Elderly livers must not be allocated for hepatitis C virus (HCV) positives, or patients with acute liver failure. In cases of markedly increased serum transaminases, donor hemodynamics is an essential consideration. A prolonged hypotension of the donor does not always lead to an increase in post-transplantation graft loss if post-OLT care is proper. Hypernatremia of less than 160 mEq/L is not an absolute contraindication to accept a liver graft per se. The presence of steatosis is an independent and determinant risk factor for the outcome. The gold standard of the diagnosis is the biopsy. This is recommended in all doubtful cases. The use of HCV+ grafts for HCV+ recipients is comparable in outcome. The leading risk factor for HCV recurrence is the actual RNA positivity of the donor. The presence of a proper anti-HBs level seems to protect from de novo HBV infection. A favourable outcome can be expected if a donation after cardiac death liver is transplanted in a favourable condition, meaning, a warm ischemia time < 30 minutes, cold ischemia time < 8-10 hours, and donor age 50-60 years. The pathway of organ quality assessment is to obtain the most relevant information (e.g. biopsy), consider the co-existing donor risk factors and the reserve capacity of the recipient, and avoid further technical issues.
authors.affiliation: a Department of Organ Transplantation, Faculty of Medicine , Institute of Surgery, University of Debrecen , Debrecen , Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Nemes
authors.affiliation: b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Gámán
authors.affiliation: c Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC , University Medical Center Rotterdam , Rotterdam , The Netherlands.
authors.forename: Wojciech G
authors.initials: WG
authors.lastname: Polak
authors.affiliation: d Department of Internal medicine and Gastroenterology , Polyclinic of Hospitallers Brothers of St. John of God , Budapest , Hungary.
authors.forename: Fanni
authors.initials: F
authors.lastname: Gelley
authors.affiliation: e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Hara
authors.affiliation: e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Ono
authors.affiliation: e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Zhassulan
authors.initials: Z
authors.lastname: Baimakhanov
authors.affiliation: b Clinic of Transplantation and Surgery , Semmelweis University , Budapest , Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Piros
authors.affiliation: e Department of Surgery , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D000367:Age Factors; D002423:Cause of Death; D046148:Donor Selection; D006304:Health Status; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors / Q000600:supply & distribution; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: HCV; Liver transplantation; biliary complications; donor; extended criteria; hepatitis C; machine perfusion; recurrence; steatosis