Single-Center Experience Using Marginal Liver Grafts in Korea

Area of Science:

• Hepatology
• Transplant Surgery
• Organ Donation

Background:

• Liver transplantation (LT) is a critical treatment for end-stage liver disease.
• A shortage of suitable organs has increased the use of marginal donor livers.
• This study evaluates outcomes of LT using marginal donors.

Purpose of the Study:

• To assess the outcomes of liver transplantation (LT) using marginal donor grafts.
• To compare patient and graft survival between marginal and standard donor groups.
• To identify factors associated with adverse outcomes in LT with marginal grafts.

Main Methods:

• Retrospective analysis of 106 deceased-donor LTs from 2009-2017.
• Marginal grafts defined by donor age >60, high serum sodium, steatosis >30%, prolonged cold ischemia, viral positivity, donation after cardiac death, or split grafts.
• Comparison of outcomes between marginal and standard graft recipients.

Main Results:

• 51 marginal grafts and 55 standard grafts were used; no significant demographic differences.
• Higher incidence of early allograft dysfunction in the marginal group.
• Lower patient (P=.023) and graft survival (P=.048) in the marginal group.
• Graft steatosis >30% independently associated with worse survival (HR, 5.947; P=.012).

Conclusions:

• Marginal donor liver grafts offer lower but acceptable survival rates.
• Graft steatosis >30% is a critical factor predicting poorer survival.
• Careful risk-benefit assessment is crucial when utilizing marginal grafts, especially those with significant steatosis.