Liver Transplantation in Adults Beyond Established Donor- and Recipient Criteria

Abstract

The huge discrepancy between the number of patients waiting for a liver transplant (LT) and the availability of donor organs have forced the transplant community to explore the use of extended criteria donors, of which old donors represent the most important group. We investigated the use of liver donors above 75 years in Scandinavia in the period 2001-2011 (n=54) and compared the results with a control group of 54 patients transplanted with donors aged 20-49 years, and could not demonstrate any difference in long term patient- (PS) or graft survival (GS) between the two groups. Performing ABO incompatible (ABOi) LT is another way of expanding the individual patient’s donor pool, although ABOi LT has been associated with significantly worse outcome compared to ABO compatible (ABOc) LT in several former studies. In our study, we investigated the results of 61 ABOi LTs performed in Gothenburg and Oslo and compared the main results to all ABOc LTs during the same period (1996-2011). We found that PS was not affected by ABOi meaning that these LTs were undoubtedly lifesaving for selected patients, but GS was significantly worse, and the complications rates were high. At the same time as waiting list are increasing, the indicati0ns and limits for which patients that should be offered LT have been pushed. We investigated the use of urgent LT in 13 patients suffering from acute liver failure either after iatrogenic injuries to the liver or due to remnant liver failure after resections. We conclude that LT was justified in the first group but it is questionable whether LT should be performed in the setting of cancer outside accepted LT-criteria. The main message in this thesis is that in the setting of organ scarcity, it is justified to use older liver donors, and that in certain rare circumstances ABOi LT is warranted as a lifesaving procedure.