Expanded Donor Criteria forLiver Transplantation

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Expanded Donor Criteria forLiver Transplantation

  1. 1. Expanded Donor Criteria for Liver Transplantation Shiva Birdi M.D.
  2. 2. Expanded Criteria - An Overview • No universal national definition • Significantly increases the availability of organs BOTTOM LINE: • These are organs with a potential higher risk of graft failure
  3. 3. Common Reasons for Selection DONOR FACTORS SPECIAL SITUATIONS • Donor with history of • Split Liver Transplantation Hepatitis C • DCD "Donation after • Donor is inactive carrier of Cardiac Death" Liver Hepatitis B • Donor Liver with Steatosis • Donor Age >70 yo
  4. 4. Donor with Hepatitis C • Only for Recipients with Hepatitis C • Need to have Biopsy evidence of NO HEPATIC DAMAGE in donor
  5. 5. Donor with Inactive Hepatitis B • Can be transplanted into patient with Hepatitis B or a patient with prior immunization for Hepatitis B • Recipients may potentially need anti-viral treatment post transplant to prevent reactivation
  6. 6. Donor Liver with Steatosis • Not the strictest of criteria • May not be appropriate for all patient populations • May have slow recovery of graft function post transplant
  7. 7. Donors of Older Age • Age > 70year old • May have slow graft function • Higher risk of Graft Failure (~3-4 % higher that younger donors)
  8. 8. Split Liver Transplantation • Single liver may be split to be transplanted in two different patients • Usually large portion for adult and smaller portion for pediatric patient • Much higher risk of complications (bleeding, vascular, biliary) • Much higher risk of failure (RR 1-4% higher)
  9. 9. Donation after Cardiac Death (DCD) • Donor does not qualify for brain death • Involves warm ischemia for a few minutes before organ is harvested after which cold ischemia is provided • Increases risk of graft failure (1-5% higher) and delayed graft function
  10. 10. Conclusion Massive shortage of donors currently exists Expanded donor criteria may provide that increased number of available livers ALL SOUNDS GOOD BUT... THERE IS AN URGENT NEED FOR PROSPECTIVE, ROBUST DATA TO SHOW THE SAFETY AND EFFICACY FOR THESE AS IT IS TOO EARLY TOO TELL FOR MANY OF THEM!

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