Liver transplantation choice of donor
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Liver transplantation choice of donor
Donation after brain death
- in 2013, a law was passed that ended a ban on transplanting organs from donors with HIV into HIV-positive recipients because of better HIV therapy as well as high waiting list mortality rates for patients with HIV [1]
- Laboratory testing generally includes:
- ABO blood type
- complete blood count (CBC)
- chemistries
- prothrombin time (PT)
- activated partial thromboplastin time (PTT)
- hepatitis B surface antigen (HBsAg)
- anti-hepatitis B core antigen (HBc)
- anti-hepatitis C virus (HCV)
- anti-HIV
- venereal disease research laboratory (VDRL)
- rapid plasma reagin (RPR)
- anti-cytomegalovirus (CMV)
- nucleic acid testing (NAT) for HIV and HCV in all or selected high risk donors [3]
ABO compatibility
- Livers are routinely matched by ABO blood type (ABO identical), although mismatched organs have been used in extreme circumstances. Mismatched organs may either be ABO compatible (eg, an organ from a donor who is type O going to a recipient who is type B) or ABO incompatible (eg, an organ from an donor who is type A going to a recipient who is type B).
- two-year graft survival was 30 percent in 17 ABO-incompatible emergency transplants compared with 76 percent in 55 ABO-compatible emergency transplants and 80 percent in 162 ABO-compatible elective transplants [42] [43].
- good outcomes have been reported among recipients with blood type O who receive an organ from a donor with blood type A2 with overall and graft survival rates that are similar to those seen when a recipient with blood type O receives an ABO-compatible organ [44].
Donor risk index [51]
The parameters most strongly associated with graft loss include increasing donor age, donation after cardiac death, and use of split/partial grafts. Other risk factors include African American donors, shorter donors, death due to cerebrovascular accident, and causes of brain death other than trauma or anoxia.
Hepatitis C-positive donors
Transplantation of livers from hepatitis C virus-positive (HCV+) donors into HCV+ recipients initially raised concerns that aggressive recurrent liver disease would result from introduction of new viral strains into the recipient. However, studies with up to five years of follow-up, along with the advent of interferon-free direct-acting antiviral treatments for HCV have reduced those concerns [62-64], and the use of HCV-positive livers has increased from 7 percent in 2010 to 17 percent in 2015 [65].
Outcomes in recipients of HCV+ grafts are discussed separately.
Hepatitis B-positive donors
Transplantation of organs from donors with serologic markers for past HBV infection has the potential to increase the donor pool, particularly in regions where HBV carriers are frequent (such as the Mediterranean region and Asia). It is generally recommended that grafts from hepatitis B core antibody (HBcAb)-positive donors should be offered to hepatitis B surface antigen (HBsAg)-positive recipients, although recipients who lack HBV markers may also be eligible provided that they receive effective HBV prophylaxis post-transplantation. The use of either hepatitis B immunoglobulin (HBIG) or an oral antiviral agent reduces the risk of HBV infection in HBsAg-negative patients who receive an HBcAb-positive liver [66-69].