The authors' clinical experience with the BAL has yielded encouraging results. A randomized, controlled, prospective trial (phase II-III) is being initiated to determine the efficacy of the system.

The use of donation after cardiac death (DCD) donors may provide a valuable source of organs for liver transplantation. Concerns regarding primary nonfunction (PNF) and intrahepatic biliary stricture (IHBSs) have limited the enthusiasm for their use. A retrospective analysis of 1436 consecutive deceased donor liver transplants performed between December 1998 and October 2006 was conducted. These included 108 DCD liver transplants, which were compared to 1328 transplants performed with organs from donors meeting the criteria for donation after brain death (DBD). The median follow-up was 48 months. The 1-, 3-, and 5-year patient survival and graft survival for DCD donors were 91.5%, 88.1%, and 88.1% and 79.3%, 74.5%, and 71.0%, respectively. The 1-, 3-, and 5-year patient survival and graft survival for DBD donors were 87.3%, 81.1%, and 77.2% and 81.6%, 74.7%, and 69.1%, respectively. Patient survival and graft survival were not significantly different between DCD donors less than 60 years old, DCD donors greater than 60 years old, and DBD donors. Causes of graft loss included IHBSs (n ϭ 9), PNF (n ϭ 4), recurrent hepatitis C virus (n ϭ 4), hepatic artery thrombosis (n ϭ 1), rejection (n ϭ 2), and patient death (n ϭ 13). Contrary to previously published data, excellent long-term patient survival and graft survival can be obtained with DCD allografts, and in our experience, they are equivalent to those obtained from DBD allografts. This discrepancy between supply and demand has resulted in significant morbidity and mortality for patients awaiting liver transplantation and has in turn resulted in the search for alternatives in order to offer liver transplantation to more patients.Attempts to increase the number of liver transplants using split liver transplantation and LDLT have met with limited success for adults and currently account for only a small percentage of the total number of liver transplants performed annually. LDLT, for example, peaked at 10% of the total number of liver transplants in 2001 and currently has declined to 5% of liver transplants, except in areas in which the average Model for End-Stage Liver Disease (MELD) score at transplant is

Liver transplantation with OD grafts is associated with rapid progression of fibrosis and decreased graft survival in patients with HCV, but not in patients without HCV. OD grafts should be considered preferentially for patients without HCV.