Abstract
It is well known that most organs for transplantation are currently procured from brain-dead donors; however, the presence of brain death is an important risk factor in liver transplantation. In addition, one of the mechanisms to avoid the shortage of liver grafts for transplant is the use of marginal livers, which may show higher risk of primary non-function or initial poor function. To our knowledge, very few reviews have focused in the field of liver transplantation using brain-dead donors; moreover, reviews that focused on both brain death and marginal grafts in liver transplantation, both being key risk factors in clinical practice, have not been published elsewhere. The present review aims to describe the recent findings and the state-of-the-art knowledge regarding the pathophysiological changes occurring during brain death, their effects on marginal liver grafts and summarize the more controversial topics of this pathology. We also review the therapeutic strategies designed to date to reduce the detrimental effects of brain death in both marginal and optimal livers, attempting to explain why such strategies have not solved the clinical problem of liver transplantation.
Highlights
The strategies applied in liver transplantation (LT) have been mainly focused in the treatment with different hormones to stabilize the hemodynamic disorders associated with Brain death (BD), whereas the strategies focused at protecting liver grafts are performed in non-BD surgical conditions
We review the therapeutic strategies designed to date to reduce the detrimental effects of brain death in both marginal and optimal livers, attempting to explain why such strategies have not solved the clinical problem of liver transplantation
The experimental conditions focused on liver graft damage associated with transplantation and on brain-dead donor, and should maximally mimic the clinical situation of LT to develop effective therapeutic strategies in this setting
Summary
It is well known that most organs for transplantation are currently procured from brain-dead donors; the presence of brain death is an important risk factor in liver transplantation. Very few reviews have focused in the field of liver transplantation using brain-dead donors; reviews that focused on both brain death and marginal grafts in liver transplantation, both being key risk factors in clinical practice, have not been published elsewhere. The present review aims to describe the recent findings and the state-of-the-art knowledge regarding the pathophysiological changes occurring during brain death, their effects on marginal liver grafts and summarize the more controversial topics of this pathology. We review the therapeutic strategies designed to date to reduce the detrimental effects of brain death in both marginal and optimal livers, attempting to explain why such strategies have not solved the clinical problem of liver transplantation. Brain death (BD) and marginal grafts are both key risk factors in clinical liver transplantation (LT). The strategies applied in LT have been mainly focused in the treatment with different hormones to stabilize the hemodynamic disorders associated with BD, whereas the strategies focused at protecting liver grafts are performed in non-BD surgical conditions
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