Changing pattern of donor selection criteria in deceased donor liver transplant: a review of literature

Abstract

During the last couple of decades, with standardization and progress in surgical techniques, immunosuppression and post liver transplantation patient care, the outcome of liver transplantation has been optimized. However, the principal limitation of transplantation remains access to an allograft. The number of patients who could derive benefit from liver transplantation markedly exceeds the number of available deceased donors. The large gap between the growing list of patients waiting for liver transplantation and the scarcity of donor organs has fueled efforts to maximize existing donor pool and identify new avenues. This article reviews the changing pattern of donor for liver transplantation using grafts from extended criteria donors (elderly donors, steatotic donors, donors with malignancies, donors with viral hepatitis), donation after cardiac death, use of partial grafts (split liver grafts) and other suboptimal donors (hypernatremia, infections, hypotension and inotropic support).

Keywords: CIT, cold ischemia time; DCD, donation after cardiac death; DGF, delayed graft function; ECD, extended criteria donor; ECMO, extra corporeal membrane oxygenation; HBIg, hepatitis B immune globulin; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HTLV, human T-lymphotropic virus; LDLT, living donor liver transplantation; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; NRP, normothermic regional perfusion; PNF, primary nonfunction; SLT, split liver transplantation; SOFT, survival outcomes following liver transplantation; SRTR, Scientific Registry of Transplant Recipients; donor pool; extended criteria donor; liver transplantation; mTOR, mammalian target of rapamycin inhibitors.