Utilization of Expanded Criteria Donors in Liver Transplantation

Abstract

Improvements in surgical techniques, immunosuppression, and post-transplantation patientcare have led to the optimization of liver transplantation outcomes. However, the waiting listfor liver transplantation is increasing at a greater pace. The large gap between the growing poolof patients waiting for liver transplantation and the scarcity of donor organs has fueled effortsto maximize existing donors and identify new sources.This article will be focused on the current state of liver transplantation using grafts from extendedcriteria donors (elderly donors, steatotic donors, donors with malignancies, donors withviral hepatitis) and from donation after cardiac death (DCD), as well as the use of partial grafts(split grafts and living-donor liver transplantation) and other suboptimal donors (donors withhypernatremia, infections, hypotension and inotropic support). Overall, broadened criteria foracceptable donor livers appear to lessen graft survival rates somewhat compared with rates forstandard criteria organs.