Deceased donor risk factors influencing liver transplant outcome

Abstract

SummaryAs the pressure for providing liver transplantation to more and more candidates increases, transplant programs have begun to consider deceased donor characteristics that were previously considered unacceptable. With this trend, attention has focused on better defining those donor factors that can impact the outcome of liver transplantation. This review examines deceased donor factors that have been associated with patient or graft survival as well as delayed graft function and other liver transplant results.In the early development of liver transplantation, clinicians were very conservative in selecting what was thought to be donor livers that were most likely to function well. This was driven partially by the fact that patient selection and transplant surgery themselves were not well understood. Both factors contribute significant uncertainty to the outcome of the transplant so liver teams did not want to introduce more uncertainty by using donor organs that were thought to carry additional risks. However, as much more evidence for selecting appropriate candidates has accumulated and the surgical procedure has become more standardized and routine, along with an increasing demand for transplantation, attention has been directed toward understanding a broader range of donor factors that can influence the outcome of liver transplantation.Over the last several years, numerous investigators have identified many liver donor factors that are important contributors to patient outcome. These studies have been facilitated by the existence of much more robust databases in which donor and recipient variables are collected for outcome analyses. In the following sections, five main categories of donor factors will be reviewed; donor demographics, donor diseases, donor cause of death and mechanism of death, donor allocation factors, and composite scores. For simplicity, this paper will address only deceased donors and focuses mostly on the donor risks themselves, recognizing that it is the combination of donor risks, recipient factors, and many other details that ultimately determine the success or failure of a given liver transplant procedure. Demographics Donor ageThere is a large body of evidence dating back more than 20 years documenting that the age of the donor is an independent risk factor for both liver transplant graft and

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The corrected donor age for hepatitis C virus–infected liver transplant recipients

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