Abstract:Objective:To evaluate the safety of using so-called “marginal donors liver (MDL)” in liver transplantation, that included livers with steatosis, parasitic infestation,HCV(+) and HBsAg(+).
Methods :The clinical data of 85 cases of primary liver transplantation in our hospital were retrospectively analyzed. Among the donor livers, 44 were MDL including 35 livers with steatosis, 6 with parasitic infection, 2 with HBsAg(+), I with HCV(+). Of the 35 livers with steatosis, the grafts were divided into 3 subgroups based on the degree of fatty infiltration. Liver function parameters including AST, ALT, TB, PT on the day of surgery and 1,2,3,7 days after surgery were monitored among the 3 sub groups, as well as the incidence of delayed nonfunction (DNF), and 3 and 6 months patient survival rate. Six hepatic graft with parasite,1 with HCV(+) and 2 with HBsAg(+) were also closely monitored as above.
Results:There were significant difference in postoperative ALT、AST、TB、PT between hepatic steatosis≥40％ group and 20％~40% group, and between hepatic steatosis 20％~40% group and＜20% group. There was no significant difference among the groups in DNF occurrence rate and 3 month, 6 month patient survival rate in the 3 groups. Correlation analysis suggested that the degree of donor liver with steatosis was positively correlated with the damage of liver function after transplation. The use of HCV(+) and HBV(+) grafts did not lead to an increased mortality.
Conclusions:Grafts with ≥20％ steatosis are relatively safe donors. As the degree of severity of steatosis increases, the risk of post-transplantation liver failure is increased. Grafts with ≥40％ steatosis should be more carefully used or avoided as far as possible, expect in emergency because the higher the degree of graft steatosis the more serious is damage of postoperative liver function. The use of an HBsAg (+) and HCV (+) cadaveric liver graft and hepatic graft with parasite may be considered when no other donor is available.