Re-use of a liver allograft; an exceptional opportunity to enlarge the organ donor pool

Abstract

Liver allograft re-use is an exceptional way of enlarging the donor pool. We describe here a case of a re-used liver allograft, originating from an insulin-intoxicated donor and transplanted at first into a recipient presenting with hyperacute liver failure due to paracetamol intoxication. Because the original recipient developed an irreversible cerebral oedema, the allograft was re-implanted electively 55.5 h later into a patient with post-viral C cirrhosis and solitary hepatocarcinoma. Both donor and recipient operations were technically successful; liver function after the second use of the graft was normal.

Reuse of Auxiliary Liver Grafts in Second Recipients With Chronic Liver Disease

“…Grafts from nonheart‐beating donors or from marginal donors, split grafts, improved allocation and alternatives to transplantation all may reduce death on the waiting list to some degree. Some cases of reuse of a liver graft from a recipient deceased after OLT have been described (2–8). This is the first description showing that orthotopic reuse of a partial auxiliary liver graft is feasible using a new technique.…”

“…Some cases of reuse of a liver graft from a recipient deceased after OLT have been described (2–8). We here describe the first two cases of orthotopic reuse of hypertrophied partial liver grafts for recipients with chronic liver disease donated by surviving recipients of PALT for ALF whose native liver regenerated.…”

Reuse of liver graft from a brain dead recipient

“…In all cases, the original recipients were in stage IV encephalopathy before undergoing transplantation. Despite excellent liver graft function, brain death occurred early after liver transplantation (4, 10, 11).…”

“…The paucity of appropriate organ donors relative to the number of patients waiting for transplantation has led to the optimization of organ utilization, resulting in the successful reuse of transplanted kidneys, hearts and livers (1–4). According to the United Network for Organ Sharing (UNOS) registry and published case reports, 23 liver grafts have been reused since 1991 (4–12). Interestingly, of the three cases transplanted for acetaminophen‐induced fulminant hepatic failure (FHF), it was possible to use not only the transplanted liver, but also the native heart and heart‐lungs, in two recipients with brain death (10, 11).…”

“…According to the United Network for Organ Sharing (UNOS) registry and published case reports, 23 liver grafts have been reused since 1991 (4–12). Interestingly, of the three cases transplanted for acetaminophen‐induced fulminant hepatic failure (FHF), it was possible to use not only the transplanted liver, but also the native heart and heart‐lungs, in two recipients with brain death (10, 11). We report herein the fourth case of brain death after liver transplantation for acetaminophen‐induced FHF in whom the transplanted liver and the heart were harvested.…”