Abstract
Liver transplantation (LT) remains the only therapeutic option offering gold standard treatment for end-stage liver disease (ESLD) and acute liver failure (ALF), as well as for certain early-stage liver tumors. Currently, the greatest challenge facing LT is the simple fact that there are not enough adequate livers for all the potential patients that could benefit from LT. Despite efforts to expand the donor pool to include living and deceased donors, organ shortage is still a major problem in many countries. To solve this problem, the use of marginal liver grafts has become an inevitable choice. Although the definition of marginal grafts or criteria for expanded donor selection has not been clarified yet, they are usually defined as grafts that may potentially cause primary nonfunction, impaired function, or late loss of function. These include steatotic livers, older donors, donors with positive viral serology, split livers, and donation after cardiac death (DCD). Therefore, to get the best outcome from these liver grafts, donor-recipient selection should be vigilant. Alcohol-related liver disease (ALD) is one of the most common indications for LT in Europe and North America. Traditionally, LT for alcoholic liver disease was kept limited for patients who have achieved 6 months of abstinence, in part due to social and ethical concerns regarding the use of a limited resource. However, the majority of patients with severe alcoholic hepatitis who fail medical therapy will not live long enough to meet this requirement. Besides, the initial results of early liver transplantation (ELT) without waiting for 6 months of abstinence period are satisfactory in severe alcoholic hepatitis (SAH). It will be important to take care of these patients from a newer perspective.
Highlights
Since the first procedure performed by Thomas E
After transplantation of HBcAb-positive grafts, the risk of de novo hepatitis B virus (HBV) (DNHB) infection in HBV-naïve recipients is 58% higher; a lower risk is observed with previous HBV vaccination or HBV infection (HBsAb+, HBcAb+) [52]
In this review, we aimed to discuss the requirement for marginal liver grafts caused by a limited donor pool and the increasing need for liver transplantation
Summary
Since the first procedure performed by Thomas E. Starzl in the 1960s, liver transplantation (LT) has become the gold standard for the treatment of end-stage liver disease (ESLD), acute liver failure, and some selected liver tumors [1]. The demand for liver has been steadily expanding. In the US, annually, about 11,000 patients with ESLD get enlisted, while annual liver transplantations are in the range of 6000–7000 [2]. To overcome the organ shortage problem, transplantation centers had to expand their criteria for donor selection. With the expansion of donor suitability criteria, the use of marginal grafts has become mandatory. Marginal grafts or expanded donors are grafts that may potentially cause primary nonfunction, impaired function, or late loss of function, there is not a clear-cut definition [3,4]
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