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
Laboratory testing for donors includes: [3]
- ABO blood type
- Complete blood count
- Prothrombin time
- Activated partial thromboplastin time
- Hepatitis B surface antigen (HBsAg)
- Anti-hepatitis B core antigen (HBc)
- Anti-hepatitis C virus (HCV)
- Anti-HIV
- Venereal disease research laboratory
- Rapid plasma reagin
- Anti-cytomegalovirus
- Nucleic acid testing for HIV and HCV
Donor risk index [51]
- A predictive model comprised of donor factors known at the time an organ is offered to quantify the risk of graft failure, and this model is known as the 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].
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].