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Donor pool expansion in liver transplantation
R Montalti1, B Nardo, R Bertelli
1Department of Surgery, ICU and Transplantation, University of Bologna, Bologna, Italy. rmontalti@hotmail.com
Transplantation Proceedings
|April 28, 2004
Summary
Older donors and those with steatosis or hepatitis B/C can be safely used in liver transplants, improving outcomes for patients awaiting organs. This approach helps reduce waiting list mortality by expanding the donor pool.
Area of Science:
- Hepatology
- Transplantation Surgery
- Organ Donation
Background:
- Donor organ shortage necessitates the use of marginal donors.
- Marginal donors include older individuals and those with steatosis or hepatitis B/C (HBcAb-/HCV)-positive status.
Purpose of the Study:
- To evaluate the safety and efficacy of using marginal donors in orthotopic liver transplantation (OLT).
- To assess outcomes associated with older donors, steatotic livers, and hepatitis B/C positive donors.
Main Methods:
- Retrospective analysis of 690 OLTs performed between 1986 and 2002.
- Utilization of 68 donors >70 years, 51 with steatosis, 44 HBcAb-positive, and 6 HCV-positive.
Main Results:
- Grafts from donors >70 years showed 72.3% 1-year graft survival; steatotic grafts had 76.8% 1-year survival.
- Hepatitis B core antibody (HBcAb)-positive donor grafts had 64.1% 1-year survival, with prophylactic treatment preventing reinfection.
- Hepatitis C virus (HCV)-positive donor grafts resulted in 1 recurrence and 1 PNF.
Conclusions:
- Marginal donors, including older individuals and those with moderate steatosis or HBcAb-/HCV-positive status, can be safely utilized.
- Using these selected marginal donors can significantly reduce mortality rates for patients on liver transplant waiting lists.