Usage and outcomes of deceased donor liver allografts with preprocurement injury from blunt trauma

Abstract

The use of extended criteria donors is an effective way of reducing the shortage of deceased donor organs. Evidence of significant liver trauma in a deceased donor usually rules out transplantation of the liver. The aim of this study was to evaluate the use and outcomes of donor livers with preprocurement trauma. Records of all 312 deceased donors with a history of trauma between January 1986 and September 2007 were reviewed. Donors with macroscopic liver injuries were identified, and data from recipient medical records were obtained. Data on declined donor offers were also evaluated. The median donor age was 20 (range, 10-57) years, and 9 of 15 (60%) were male. The liver injuries were predominantly lacerations (grades 1-5) and vascular injury. The right lobe was resected because of extensive damage in 3 cases. This resulted in 2 left lobes (back-table cut-down) and 1 left lateral segment allograft (in situ split). For the 15 recipients, the median age was 43 (3-69) years. Primary nonfunction was not seen. There was no difference in survival between whole and partial allografts. Three deaths occurred within 3 months post-transplantation. During the same period, 42 of 1405 donor offers (3%) were declined because of extensive liver trauma or major ongoing intra-abdominal hemorrhage. In conclusion, the use of donor livers with preexisting trauma leads to acceptable outcomes. Strategies to deal with trauma include resection of the right lobe if required. Use of deceased donor livers with injury is a safe way to expand the donor pool.