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Excerpt
Liver transplantation has enjoyed increasing success in recent years secondary to advances in technical skill, patient management, and immunosuppression. This has resulted in general expansion of the active waiting list despite an ongoing serious donor shortage. This predicament has forced most programs to accept livers that traditionally would have been refused. This study was designed to look for differences between the traditional liver donor and the marginal donor in terms of preprocurement condition and post transplant liver function. Between January, 1996 and November, 1997, 121 liver transplants were performed at the Medical College of Virginia. The study population consisted of retrospective review of 113 donor records and 114 liver recipient charts (one split liver). Marginal donors were predefined as those displaying any one of the following characteristics; Age > 55, AST>150, ALT>150, PT>16, total bilirubin > 2.0, and systolic blood pressure < 80 for ≥ 30 minutes. Recipient data consisted of age, UNOS status, length of stay, maximum AST, ALT, Bili, PT, as well as time to return to normal values. Statistical analysis was performed with the Student t test with P<0.05 considered significant. The mean donor age was 33.2±16.9 (median 32.4) with a range of .5 to 68.6 years. Sixteen donors (14%) were >55 years old. The mean age of all recipients was 45.6±14.3 (median 46) with 57% males and 43% females. The overall patient survival was 86%. Seven patients (6%) underwent re-transplantation. Table
Conclusions: (1) There is no statistical difference in survival or immediate graft function with respect to marginal versus non marginal livers; (2) Non marginal livers had a greater time until reaching normal AST (<75) and ALT (<75) (p<0.05) (3) There is no differences in length of stay or UNOS data between the two groups; (4) The use of marginal donors is justified for the increasing number of patients requiring liver transplantation in the present era of liver donor shortage.
