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== Overview ==
== Overview ==
Liver transplantation choice of donorLiver transplantation choice of donor includes laboratory testing for donors includes [[ABO blood group system|ABO blood type]], [[Complete blood count]], [[Prothrombin time]], [[Activated partial thromboplastin time]], [[Hepatitis B surface antigen]], anti-hepatitis B core antigen, anti-hepatitis C virus, anti-HIV [[antibody]], [[Venereal disease research laboratory (VDRL) test|venereal disease research laboratory]], [[Rapid plasma reagent|rapid plasma reagin]], anti-[[cytomegalovirus]] [[antibody]], and nucleic acid testing for [[Human Immunodeficiency Virus (HIV)|HIV]] and [[Hepatitis C|HCV]]. Donor risk index is a predictive model comprised of donor factors known at the time an organ is offered to quantify the risk of graft failure.


== Liver transplantation choice of donor ==
== Liver transplantation choice of donor ==
=== '''Donation after brain death''' ===
Laboratory testing for donors includes:<ref name="pmid19191766">{{cite journal| author=Kucirka LM, Alexander C, Namuyinga R, Hanrahan C, Montgomery RA, Segev DL| title=Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs. | journal=Am J Transplant | year= 2009 | volume= 9 | issue= 3 | pages= 620-8 | pmid=19191766 | doi=10.1111/j.1600-6143.2008.02522.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191766  }}</ref>
Laboratory testing for donors includes:<ref name="pmid19191766">{{cite journal| author=Kucirka LM, Alexander C, Namuyinga R, Hanrahan C, Montgomery RA, Segev DL| title=Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs. | journal=Am J Transplant | year= 2009 | volume= 9 | issue= 3 | pages= 620-8 | pmid=19191766 | doi=10.1111/j.1600-6143.2008.02522.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191766  }}</ref>
* [[ABO blood group system|ABO blood type]]<ref name="pmid22874840">{{cite journal| author=Kluger MD, Guarrera JV, Olsen SK, Brown RS, Emond JC, Cherqui D| title=Safety of blood group A2-to-O liver transplantation: an analysis of the United Network of Organ Sharing database. | journal=Transplantation | year= 2012 | volume= 94 | issue= 5 | pages= 526-31 | pmid=22874840 | doi=10.1097/TP.0b013e31825c591e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874840  }}</ref>
* [[ABO blood group system|ABO blood type]]<ref name="pmid22874840">{{cite journal| author=Kluger MD, Guarrera JV, Olsen SK, Brown RS, Emond JC, Cherqui D| title=Safety of blood group A2-to-O liver transplantation: an analysis of the United Network of Organ Sharing database. | journal=Transplantation | year= 2012 | volume= 94 | issue= 5 | pages= 526-31 | pmid=22874840 | doi=10.1097/TP.0b013e31825c591e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874840  }}</ref>
Line 24: Line 24:
=== '''Donor risk index''' ===
=== '''Donor risk index''' ===
* 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.<ref name="pmid16539636">{{cite journal| author=Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA et al.| title=Characteristics associated with liver graft failure: the concept of a donor risk index. | journal=Am J Transplant | year= 2006 | volume= 6 | issue= 4 | pages= 783-90 | pmid=16539636 | doi=10.1111/j.1600-6143.2006.01242.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16539636  }}</ref>  
* 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.<ref name="pmid16539636">{{cite journal| author=Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA et al.| title=Characteristics associated with liver graft failure: the concept of a donor risk index. | journal=Am J Transplant | year= 2006 | volume= 6 | issue= 4 | pages= 783-90 | pmid=16539636 | doi=10.1111/j.1600-6143.2006.01242.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16539636  }}</ref>  
* The parameters most strongly associated with graft loss include increasing donor age, donation after cardiac death, and use of split/partial grafts.  
* The parameters most strongly associated with graft loss include increasing donor age, donation after cardiac death, and use of split grafts.  
* Death due to a cerebrovascular accident
* The index includes:
* Causes of brain death other than trauma or anoxia
{| class="wikitable"
|Age
|-
| colspan="1" |<40
|-
| colspan="1" |40-49
|-
| colspan="1" |50-59
|-
| colspan="1" |60-69
|-
| colspan="1" |>69
|-
|Cause of Death
|-
| colspan="1" |Trauma
|-
| colspan="1" |Anoxia
|-
| colspan="1" |Cerebrovascular Accident
|-
| colspan="1" |Other
|-
|Race
|-
|African American
|-
|White
|-
|Other
|-
|Donation after Cardiac Death
|-
|Partial/Split Liver Graft
|-
|Height
|-
|Organ Location
|-
|Cold time
|}
1.00
 
40-49 1.17
 
50-59 1.32
 
60-69 1.53
 
>70 1.65
 
1.19
 
1.07
 
1.16
 
1.20
 
1.51
 
1.52
 
'''Hepatitis C-positive donors'''
'''Hepatitis C-positive donors'''
* Transplantation of livers from hepatitis C virus-positive donors into HCV+ recipients initially may cause recurrent liver disease due to introduction of new viral strains into the recipient.<ref name="pmid27456927">{{cite journal| author=Bowring MG, Kucirka LM, Massie AB, Luo X, Cameron A, Sulkowski M et al.| title=Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era. | journal=Am J Transplant | year= 2017 | volume= 17 | issue= 2 | pages= 519-527 | pmid=27456927 | doi=10.1111/ajt.13976 | pmc=5266634 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27456927  }}</ref>
* Transplantation of livers from hepatitis C virus-positive donors into [[Hepatitis C|HCV]]+ recipients initially may cause recurrent liver disease due to introduction of new viral strains into the recipient.<ref name="pmid27456927">{{cite journal| author=Bowring MG, Kucirka LM, Massie AB, Luo X, Cameron A, Sulkowski M et al.| title=Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era. | journal=Am J Transplant | year= 2017 | volume= 17 | issue= 2 | pages= 519-527 | pmid=27456927 | doi=10.1111/ajt.13976 | pmc=5266634 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27456927  }}</ref>
'''Hepatitis B-positive donors'''
'''Hepatitis B-positive donors'''
* Liver transplantation from donors with serologic markers for HBV infection has the potential to increase the donor pool.<ref name="pmid11552208">{{cite journal| author=Marroquin CE, Marino G, Kuo PC, Plotkin JS, Rustgi VK, Lu AD et al.| title=Transplantation of hepatitis C-positive livers in hepatitis C-positive patients is equivalent to transplanting hepatitis C-negative livers. | journal=Liver Transpl | year= 2001 | volume= 7 | issue= 9 | pages= 762-8 | pmid=11552208 | doi=10.1053/jlts.2001.27088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11552208  }}</ref>  
* Liver transplantation from donors with serologic markers for [[Hepatitis B virus|HBV]] infection has the potential to increase the donor pool.<ref name="pmid11552208">{{cite journal| author=Marroquin CE, Marino G, Kuo PC, Plotkin JS, Rustgi VK, Lu AD et al.| title=Transplantation of hepatitis C-positive livers in hepatitis C-positive patients is equivalent to transplanting hepatitis C-negative livers. | journal=Liver Transpl | year= 2001 | volume= 7 | issue= 9 | pages= 762-8 | pmid=11552208 | doi=10.1053/jlts.2001.27088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11552208  }}</ref>  
* It is generally recommended that grafts from hepatitis B core antibody positive donors should be offered to hepatitis B surface antigen positive recipients.  
* It is generally recommended that grafts from hepatitis B core antibody positive donors should be offered to [[hepatitis B surface antigen]] positive recipients.  
* Recipients who lack [[Hepatitis B virus|HBV]] markers may also be eligible provided that they receive effective [[Hepatitis B virus|HBV]] [[prophylaxis]] post-transplantation.  
* Recipients who lack [[Hepatitis B virus|HBV]] markers may also be eligible provided that they receive effective [[Hepatitis B virus|HBV]] [[prophylaxis]] post-transplantation.  
* The use of [[hepatitis B immunoglobulin]] or an oral [[Antiviral Therapy|antiviral agent]] reduces the risk of [[Hepatitis B virus|HBV]] infection in [[HBsAg]]-negative patients who receive an HBcAb-positive liver. [66-69]. 
* The use of [[hepatitis B immunoglobulin]] or an oral [[Antiviral Therapy|antiviral agent]] reduces the risk of [[Hepatitis B virus|HBV]] infection in [[HBsAg]]-negative patients who receive an HBcAb-positive liver.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 18:21, 6 January 2018


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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Overview

Liver transplantation choice of donorLiver transplantation choice of donor includes laboratory testing for donors includes ABO blood type, Complete blood count, Prothrombin time, Activated partial thromboplastin time, Hepatitis B surface antigen, anti-hepatitis B core antigen, anti-hepatitis C virus, anti-HIV antibody, venereal disease research laboratory, rapid plasma reagin, anti-cytomegalovirus antibody, and nucleic acid testing for HIV and HCV. Donor risk index is a predictive model comprised of donor factors known at the time an organ is offered to quantify the risk of graft failure.

Liver transplantation choice of donor

Laboratory testing for donors includes:[1]

Donor risk index

  • 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.[3]
  • The parameters most strongly associated with graft loss include increasing donor age, donation after cardiac death, and use of split grafts.
  • The index includes:
Age
<40
40-49
50-59
60-69
>69
Cause of Death
Trauma
Anoxia
Cerebrovascular Accident
Other
Race
African American
White
Other
Donation after Cardiac Death
Partial/Split Liver Graft
Height
Organ Location
Cold time

1.00

40-49 1.17

50-59 1.32

60-69 1.53

>70 1.65

1.19

1.07

1.16

1.20

1.51

1.52

Hepatitis C-positive donors

  • Transplantation of livers from hepatitis C virus-positive donors into HCV+ recipients initially may cause recurrent liver disease due to introduction of new viral strains into the recipient.[4]

Hepatitis B-positive donors

  • Liver transplantation from donors with serologic markers for HBV infection has the potential to increase the donor pool.[5]
  • It is generally recommended that grafts from hepatitis B core antibody positive donors should be offered to hepatitis B surface antigen positive recipients.
  • Recipients who lack HBV markers may also be eligible provided that they receive effective HBV prophylaxis post-transplantation.
  • The use of hepatitis B immunoglobulin or an oral antiviral agent reduces the risk of HBV infection in HBsAg-negative patients who receive an HBcAb-positive liver.

References

  1. ↑ Kucirka LM, Alexander C, Namuyinga R, Hanrahan C, Montgomery RA, Segev DL (2009). "Viral nucleic acid testing (NAT) and OPO-level disposition of high-risk donor organs". Am J Transplant. 9 (3): 620–8. doi:10.1111/j.1600-6143.2008.02522.x. PMID 19191766.
  2. ↑ Kluger MD, Guarrera JV, Olsen SK, Brown RS, Emond JC, Cherqui D (2012). "Safety of blood group A2-to-O liver transplantation: an analysis of the United Network of Organ Sharing database". Transplantation. 94 (5): 526–31. doi:10.1097/TP.0b013e31825c591e. PMID 22874840.
  3. ↑ Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA; et al. (2006). "Characteristics associated with liver graft failure: the concept of a donor risk index". Am J Transplant. 6 (4): 783–90. doi:10.1111/j.1600-6143.2006.01242.x. PMID 16539636.
  4. ↑ Bowring MG, Kucirka LM, Massie AB, Luo X, Cameron A, Sulkowski M; et al. (2017). "Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era". Am J Transplant. 17 (2): 519–527. doi:10.1111/ajt.13976. PMC 5266634. PMID 27456927.
  5. ↑ Marroquin CE, Marino G, Kuo PC, Plotkin JS, Rustgi VK, Lu AD; et al. (2001). "Transplantation of hepatitis C-positive livers in hepatitis C-positive patients is equivalent to transplanting hepatitis C-negative livers". Liver Transpl. 7 (9): 762–8. doi:10.1053/jlts.2001.27088. PMID 11552208.
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