Feasibility of using marginal liver grafts in living donor liver transplantation

Abstract

Liver transplantation (LT) is one of the most effective treatments for end-stage liver disease caused by related risk factors when liver resection is contraindicated. Additionally, despite the decrease in the prevalence of hepatitis B virus (HBV) over the past two decades, the absolute number of HBsAg-positive people has increased, leading to an increase in HBV-related liver cirrhosis and hepatocellular carcinoma. Consequently, a large demand exists for LT. While the wait time for patients on the donor list is, to some degree, shorter due to the development of living donor liver transplantation (LDLT), there is still a shortage of liver grafts. Furthermore, recipients often suffer from emergent conditions, such as liver dysfunction or even hepatic encephalopathy, which can lead to a limited choice in grafts. To expand the pool of available liver grafts, one option is the use of organs that were previously considered “unusable” by many, which are often labeled “marginal” organs. Many previous studies have reported on the possibilities of using marginal grafts in orthotopic LT; however, there is still a lack of discussion on this topic, especially regarding the feasibility of using marginal grafts in LDLT. Therefore, the present review aimed to summarize the feasibility of using marginal liver grafts for LDLT and discuss the possibility of expanding the application of these grafts.

The current status and outcomes of pediatric liver transplantation in western China: A multi‐center retrospective study

“…In addition, with the global development of surgical procedures, perioperative management, and immunosuppression regimens, accompanied by the establishment and updating of guidelines, pediatric LT has evolved rapidly, including in China. As we recently found that donor liver quality affects the post‐LT prognosis, 25 this quality is now controlled strictly, and the number of DDLTs performed has declined slightly. We now use both methods to mitigate the problems of organ shortage and save more children's lives.…”

“…In addition, with the global development of surgical procedures, perioperative management, and immunosuppression regimens, accompanied by the establishment and updating of guide-lines, pediatric LT has evolved rapidly, including in China. As we recently found that donor liver quality affects the post-LT prognosis,25…”

Relevance of SIRS and Sepsis in Pediatric Liver Transplantation

“…Graft to recipient size mismatch was defined according to graft weight in relation to body weight of the recipient (graft-recipient ratio). Graft weight of less than 2% of patient body weight was defined as "small for size", graft size of more than 4% of patient body weight was defined as "large for size" [24] [25].…”

IL-17a exacerbates hepatic ischemia–reperfusion injury in fatty liver by promoting neutrophil infiltration and mitochondria-driven apoptosis

“…Hepatic IR injury also increases the risks of post‐LT tumor recurrence and metastasis by activating hypoxia and angiogenesis signaling pathways for tumor cell growth, migration, and invasion 6,7 . On the other hand, due to the shortage of liver donors, using marginal liver grafts, including fatty liver (steatosis less than 30%) in LT is feasible and acceptable in selected patients 8,9 . However, donor steatosis increases the risk of postoperative morbidity and mortality 10‐12 .…”