Donor Retrieval Research Articles

Donor Lung Preservation at 10 °C: Clinical and Logistical Impact

IntroductionCold static donor lung preservation at 10°C appears to be a promising method to safely extend the cold ischemic time (CIT) and improve lung transplant (LTx) logistics. MethodsLTx from November 2021 to February 2023 were included in this single institution, prospective, non-randomized study comparing prolonged preservation at 10°C versus standard preservation on ice. The inclusion criteria for 10°C preservation were suitable grafts for LTx without any donor retrieval concerns. Primary endpoint: primary graft dysfunction (PGD) grade-3 at 72-h. Secondary endpoints: clinical outcomes, cytokine profile and logistical impact. ResultsThirty-three out of fifty-seven cases were preserved at 10°C. Donor and recipient characteristics were similar across the groups. Total preservation times (h:min) were longer (p<0.001) in the 10°C group [1st lung: median 12:09 (IQR 9:23–13:29); 2nd: 14:24 (12:00–16:20)] vs. standard group [1st lung: median 5:47 (IQR 5:18–6:40); 2nd: 7:15 (6:33–7:40)]. PGD grade-3 at 72-h was 9.4% in 10°C group vs. 12.5% in standard group (p=0.440). Length of mechanical ventilation (MV), ICU and hospital stays were similar in both groups. Thirty and ninety-day mortality rates were 0% in 10°C group (vs. 4.2% in standard group). IL-8 concentration was significantly higher 6-h post-LTx in the standard group (p=0.025) and IL-10 concentration was increased 72-h post-LTx in the 10°C group (p=0.045). ConclusionsPreservation at 10°C may represent a safe and feasible strategy to intentionally prolong the CIT. In our center, extending the CIT at 10°C may allow for semi-elective LTx and improve logistics with similar outcomes compared to the current standard preservation on ice.

Risk Factors of Corneal Donor Contamination and Post-Keratoplasty Infectious Complication

Introduction &amp; Objectives : Infectious keratitis and endophthalmitis are rare yet devastating complications of corneal transplantation. Some studies have demonstrated increased incidence of infectious post-keratoplasty complications are related to contaminated corneal donor, although its risk factors remain controversial. This study provides concise review on possible risk factors of corneal donor contamination which related to post-keratoplasty infectious complications.&#x0D; Methods : This literature review was conducted by searching PubMed and Proquest for “corneal donor contamination” AND (“infectious complication” OR infection OR endophthalmitis) from the period of 2018-2023. Relevant articles were reviewed and selected for further understanding regarding various risk factors of corneal donor contamination leading to post-keratoplasty infectious complications and its preventive strategies.&#x0D; Results : The rate of corneal contamination varied between studies, ranging from 1,3 to 7,8%. The most common risks of contamination are donor’s diseases (e.g. cardiovascular, cerebrovascular accident) and prolonged time between death and donor retrieval. Longer preservation time (&gt;5 days), environmental situation (temperature and humidity), and prolonged treatment duration on intensive care unit (&gt;4 days) are also considered as its risk factors. Corneoscleral rim culture, addition of antifungal and antibacterial to corneal storage medium, and shortening of corneal processing time should be considered as probable preventive strategies.&#x0D; Conclusion : Donor diseases, prolonged donor retrieval time from death, and longer donor preservation and hospitalization duration, are associated with higher rates of corneal donor contamination. Rapid retrieval and donor handling time, together with corneoscleral rims culture, at least for fungus regarding its better predictive values, should be taken into consideration by corneal donors providing eye banks.

Commentary: Potential transmissibility of SARS-CoV-2 infection via donor corneal tissue.

Commentary: Potential transmissibility of SARS-CoV-2 infection via donor corneal tissue.

Repeated Freezing Procedures Preserve Structural and Functional Properties of Amniotic Membrane for Application in Ophthalmology.

For decades, the unique regenerative properties of the human amniotic membrane (hAM) have been successfully utilized in ophthalmology. As a directly applied biomaterial, the hAM should be available in a ready to use manner in clinical settings. However, an extended period of time is obligatory for performing quality and safety tests. Hence, the low temperature storage of the hAM is a virtually inevitable step in the chain from donor retrieval to patient application. At the same time, the impact of subzero temperatures carries an increased risk of irreversible alterations of the structure and composition of biological objects. In the present study, we performed a comprehensive analysis of the hAM as a medicinal product; this is intended for a novel strategy of application in ophthalmology requiring a GMP production protocol including double freezing–thawing cycles. We compared clinically relevant parameters, such as levels of growth factors and extracellular matrix proteins content, morphology, ultrastructure and mechanical properties, before and after one and two freezing cycles. It was found that epidermal growth factor (EGF), transforming growth factor beta 1 (TGF-β1), hepatocyte growth factor (HGF), basic fibroblast growth factor (bFGF), hyaluronic acid, and laminin could be detected in all studied conditions without significant differences. Additionally, histological and ultrastructure analysis, as well as transparency and mechanical tests, demonstrated that properties of the hAM required to support therapeutic efficacy in ophthalmology are not impaired by dual freezing.

A Survey of the Practices of Storage and Transport for Donor Heart in India

Background: Heart transplant remains the gold standard for the treatment of end-stage heart failure. The most common method of donor heart preservation, during transport, is “triple-bag technique” with static cold storage (SCS). The safe duration of storage (ischemic time) for a donor heart with SCS is 4 h shortest among all the transplantable solid organs. One of the factors determining the donor heart's quality is the storage and transport of the donor organ. This study identified the centers which perform heart transplants routinely (≥7 per year) for the past 3 years and compared the differences between their donor heart storage and transport practices. Methodology: After obtaining ethical clearance from the Institutional Ethics Committee, this survey was done among the centers performing heart transplants in India. Centers performing an average of ≥7 heart transplants per year for the past consecutive 3 years were identified and included in the study. Centers that refused to participate or did not respond to a maximum of 3 reminders to send the filled questionnaire were excluded from the survey. A total of 11 transplant teams fulfilled the inclusion criteria, but only eight units responded to the request. The authors identified the team leaders in all the transplant teams and obtained concurrence before sharing an indigenous questionnaire about the practice of storage and transport of donor heart followed in their centers. Teams were contacted by digital platforms and telephone. Results: The analysis of current practices for donor heart preservation reveals that the triple-bag technique is the most commonly used method for SCS of donor heart, and Custodiol HTK is the most commonly used solution for cardioplegia. The dose of Custodiol varies between 25 and 50 ml/kg in different centers. It is also a common practice to immerse the heart in cold Custodiol solution in the first bag. Although any donor retrieval team does not measure the temperature, every team claims the temperature of the preservative solution used for flushing is 0°C–4°C. All the participating teams use ice cubes or slush in the transport box around the heart encased in 3 plastic bags. Conclusions: The authors of this survey conclude that the triple bag technique use may not be essential and can be converted to a two-bag technique as practiced by a couple of units. The use of cold Custodiol solution in the first bag probably has no rationale, and the use of 0.9% saline is a non-inferior cost-effective option. Ice slush may be avoided in the first bag because of the theoretical possibility of triggering a freeze in the donor heart.

Retrieval Practice or Overall Donor and Recipient Risk: What Impacts on Outcomes After Donation After Circulatory Death Liver Transplantation in the United Kingdom?

Parameters of retrieval surgery are meticulously documented in the United Kingdom, where up to 40% of livers are donation after circulatory death (DCD) donations. This retrospective analysis focuses on outcomes after transplantation of DCD livers, retrieved by different UK centers between 2011 and 2016. Donor and recipient risk factors and the donor retrieval technique were assessed. A total of 236 DCD livers from 9 retrieval centers with a median UK DCD risk score of 5 (low risk) to 7 points (high risk) were compared. The majority used University of Wisconsin solution for aortic flush with a median hepatectomy time of 27-44minutes. The overall liver injury rate appeared relatively high (27.1%) with an observed tendency toward more retrieval injuries from centers performing a quicker hepatectomy. Among all included risk factors, the UK DCD risk score remained the best predictor for overall graft loss in the multivariate analysis (P<0.001). In high-risk and futile donor-recipient combinations, the occurrence of liver retrieval injuries had negative impact on graft survival (P=0.023). Expectedly, more ischemic cholangiopathies (P=0.003) were found in livers transplanted with a higher cumulative donor-recipient risk. Although more biliary complications with subsequent graft loss were found in high-risk donor-recipient combinations, the impact of the standardized national retrieval practice on outcomes after DCD liver transplantation was minimal.

Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant: Our Experience of Two Patients

Study ObjectiveTo report the first ever laparoscopic-assisted live donor uterus retrieval in 2 patients for uterus transplant. DesignCase study (Canadian Task Force classification III). SettingGalaxy CARE Laparoscopy Institute, Pune, India. PatientsTwo patients with absolute uterine factor infertility with their mothers as donors. InterventionsIn vitro fertilization and uterine transplant. Measurements and Main ResultsA 12-member team was formed, and approval for transplant was obtained from the institutional review board. Pretransplant, in vitro fertilization for both patients was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus and harvested vessels were retrieved by a small abdominal incision to prevent injury and infection. The uterus was transplanted in the recipients by end to side anastomosis of the harvested vessels to external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. Surgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 6 months were measured. Operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. Recipient surgery time was 4 hours. There were no intraoperative or immediate postoperative complications. Both the recipients started menstruating after 34 days and 48 days, respectively, and have had 6 cycles of menses at regular intervals. Uterine artery Doppler showed good flow in both patients. Hysteroscopy-guided cervical biopsies were used as a method of surveillance of graft rejection after uterine transplant. Office hysteroscopy was done after 2 months in both patients, and hysteroscopy-guided endometrial and cervical biopsies were taken. Minimal slough was seen on the endometrium in the patient with Mayer-Rokitansky-Küster-Hauser syndrome, which was removed. Repeat hysteroscopy after 10 days showed a healthy endometrium. ConclusionsLaparoscopic-assisted uterus donor retrieval is feasible and affords all the advantages of a minimally invasive technique, thereby reducing the morbidity of the procedure. It helps in better dissection of the vessels, shortens the operative time, and helps to minimize tissue handling of the harvested uterus and vessels.

Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant

Study ObjectiveThe authors present the first ever laparoscopic-assisted uterus retrieval in a live donor for uterus transplant. DesignA step-by-step surgical demonstration. SettingGalaxy CARE Laparoscopy Institute, Pune, India. PatientsTwo patients, ages 21 and 26 years, with Mayer-Rokitansky-Küster-Hauser syndrome and Asherman syndrome, respectively, with their mothers as donors. InterventionsA 12-member team was formed. After a review of the available literature on uterine transplant, a protocol was formulated and submitted to the Institutional Review Board (IRB). Approval from the Institutional Review Board was obtained. Thorough screening of the candidates was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus was retrieved through a small abdominal incision, to prevent any injury to the uterus and harvested vessels. Uterus was transplanted in the recipients by end-to-side anastomosis of the harvested vessels to the external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. Measurements and Main ResultsSurgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 4 months. The operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. The recipient surgery was completed in 4 hours. There were no intraoperative or immediate postoperative complications. Both recipients started menstruating after 34 days and 48 days, respectively, and have had 3 cycles of menses at regular intervals to date. After discharge, follow-up cervical biopsies at 3 weekly intervals showed no signs of rejection. Uterine artery Doppler ultrasound showed good flow in both patients. ConclusionLaparoscopic-assisted donor retrieval is feasible and affords all advantages of a minimally invasive technique. It helps in better dissection of vessels, shortens the operative time, and helps minimize tissue handling, thereby reducing the morbidity of the procedure.

The utility of serial echocardiograms for organ procurement in brain death.

Heart transplantation rates are limited by a shortage of donor hearts, and left ventricular dysfunction is an important cause. We hypothesized that an early echocardiographic evaluation in severe brain injury (performed within 12hours from ICU admission) could allow the detection of potentially reversible left ventricular (LV) abnormalities and thus the initiation of tailored treatment whose effects could be assessed at a second echocardiogram performed when brain death develops. We assessed this hypothesis in 49 patients with severe brain injury who were potential heart donors. A reduction in LV ejection fraction (LVEF) (<55%) was present in five patients (10.2%): diffuse hypokinesia in three patients (6.1%), segmental wall motion abnormalities in two (4.1%). Two patients showed apical ballooning (normal LVEF). The three patients with diffuse hypokinesia showed, at the echocardiogram performed 12hours later, a complete recovery of wall motion and LVEF. Among patients with apical ballooning, a complete resolution was observed in both patients. Two patients were considered potentially eligible for heart donation, resulting in 20% increase in donor retrieval rate. In serious encephalic lesions, potentially evolving toward brain death, echocardiography performed after ICU admission allowed the identification of LV abnormalities, which could be specifically treated with complete resolution.

Finger reconstruction in children by the transfer of hand segments

Aim. We aimed to evaluate the possibility of reconstruction of amputated fingers using various methods of hand segment transfer in children.&#x0D; Materials and methods. A retrospective analysis of the reconstruction of the first and triphalangeal fingers of an injured hand using a segment transfer method in 31 children was performed. Eleven patients had a mechanical injury; 12, a gunshot injury; 7, a burn injury; and 1, a freezing injury. The reconstruction of 32 fingers was performed by the transfer of an intact triphalangeal finger (3), defective finger (3), finger stump (14), and a metacarpal (12). The surgery was performed using traditional (16) and original (16) methods. In 26 cases, skin grafting using donor resources from remote areas was required for segment transfer. Newly developed approaches enable the transfer of the defective finger and any stump of the main finger phalanges and metacarpals, irrespective of their location, amputation level, hand defect character, level of cicatrical changes of the soft tissues, and impaired circulation, while adequately preventing ischemic complications.&#x0D; Results. Survival of all the transferred segments, including those with total cicatrical tissue changes and vascular disruptions, was achieved. The analysis of results showed that handgrip was restored in 31 hands. The best results were achieved in the transfer of intact fingers. Transfer of the utile segments enabled the reconstruction of the double-sided grip with minimum donor retrieval. Two-point discrimination was 2 mm for finger transfer, 4.5 mm for finger stump, and 6.5–7.4 mm for the metacarpal stump.&#x0D; Conclusion. The transfer of injured hand segments in children for finger reconstruction provides acceptable functional and anatomical results. This method can be used in combination with other finger reconstruction methods. Advanced technical and tactical approaches have widened the criteria of segment suitability and indications for the use of this method.

First two bilateral hand transplantations in India (Part 2): Technical details.

Introduction:This article deals with two patients who underwent bilateral hand transplantation following amputation of both upper limbs at the distal third of the foream.Materials and Methods:The first patient had a history of loss of hands in a train accident , with possiblity of a run over element during the injury. The second patient lost his both hands in a mine blast. The preoperative work up included detailed clinical and psychological evaluation. The donor retrieval was similar in both the cases and the donors were housed in our own instittution. The donor preparation, recipient preparation and the transplant procedure was similar except for the need of primary tendon transfers in the left hand of the first patient.Results:The first patient needed a free flap transfer to cover compromised skin flap on the left hand on the second day. The second hand transplant was uneventful. Both the recipients are now back to their normal daily routines.Conclusions:Hand transplantation is a potentially life altering procedure, but to optimise the results, it is imperative that there is a meticulous planning and diligent execution with utmost importance to the detail coupled with a synchronised team effort.

(760) - Donor Time Management in Heart Transplantation - A Single-Center Experience

Effective timing of donor retrieval is paramount in optimising effective utilization of a finite brain-dead donor pool. In this study, we analysed heart transplantation data, focusing on the temporal trends and influences of key donor time management intervals on recipient survival.

Evaluation of blood donor deferral causes: a tertiary-care center-based study

Background: Donor selection is necessary in addition to the screenings of blood bags for infectious diseases. Deferrals lead to loss of precious blood/components available for transfusion. For preventing this, we should be having knowledge of causes of deferral and their frequency. Objectives: To evaluate blood donor deferral causes and possibility of donor retrieval. Materials and Methods: Causes of donor deferral were evaluated retrospectively from January 2013 to July 2014 in the blood bank of C.U. Shah Medical College, Surendranagar, Gujarat, India. Totally 14,347 donors were screened, and of them, 660 donors were considered to be deferred. Results: Temporary deferral was more common than permanent deferral. The most common cause in permanent deferral was HBsAg positivity (23.64%). Causes among temporary deferral were anemia (Hb < 12.5%) (24.11%), followed by jaundice, weight < 45 kg, age older than 18 years, patients on antibiotic, previous donation in last 3 months, typhoid in last 1 year, dog bite, and so on. Conclusion: Analysis of deferral patterns may help medical personnel and doctors to be more focused in donor screening, especially of those who are having higher frequency. Temporarily deferred donors require proper follow-up and management so as not to lead to a diminished supply of future donors. It is important to determine the rate and causes of blood donor deferral for the safety of blood/component transfusion and to guide the recruitment efforts to prevent loss of precious blood/components at the local, national, and international levels.

Lung donor selection criteria.

The criteria that define acceptable physiologic and social parameters for lung donation have remained constant since their empiric determination in the 1980s. These criteria include a donor age between 25-40, a arterial partial pressure of oxygen (PaO2)/FiO2 ratio greater than 350, no smoking history, a clear chest X-ray, clean bronchoscopy, and a minimal ischemic time. Due to the paucity of organ donors, and the increasing number of patients requiring lung transplant, finding a donor that meets all of these criteria is quite rare. As such, many transplants have been performed where the donor does not meet these stringent criteria. Over the last decade, numerous reports have been published examining the effects of individual acceptance criteria on lung transplant survival and graft function. These studies suggest that there is little impact of the historical criteria on either short or long term outcomes. For age, donors should be within 18 to 64 years old. Gender may relay benefit to all female recipients especially in male to female transplants, although results are mixed in these studies. Race matched donor/recipients have improved outcomes and African American donors convey worse prognosis. Smoking donors may decrease recipient survival post transplant, but provide a life saving opportunity for recipients that may otherwise remain on the transplant waiting list. No specific gram stain or bronchoscopic findings are reflected in recipient outcomes. Chest radiographs are a poor indicator of lung donor function and should not adversely affect organ usage aside for concerns over malignancy. Ischemic time greater than six hours has no documented adverse effects on recipient mortality and should not limit donor retrieval distances. Brain dead donors and deceased donors have equivalent prognosis. Initial PaO2/FiO2 ratios less than 300 should not dissuade donor organ usage, although recruitment techniques should be implemented with intent to transplant.

(739) - Process Improvement in Thoracic Organ Donor Retrieval: Implementation of a Donor Assessment Checklist

(739) - Process Improvement in Thoracic Organ Donor Retrieval: Implementation of a Donor Assessment Checklist

High Cumulative Live Births in Oocyte Donation Cycles with Cryopreservation of All Embryos

Background: Cryopreservation of all embryos in stimulated IVF cycles is occasionally necessary. Although it is known that frozen embryo transfer results in lower live birth rates per transfer, there is limited information regarding expected cumulative live birth rates for patients who are in this particular scenario. Methods: The objective was to evaluate long-term outcomes in cycles undergoing pronuclear cryopreservation of all embryos utilizing a retrospective analysis of 154 consecutive recipients from 1995 to 2006. Results: The cumulative rate of first live birth per retrieval was 66.2%, with a 36.4% live birth rate per frozen embryo transfer. Following an average 2.2 ± 0.98 transfers, 32.6% (17/52) of patients who never delivered had remaining embryos making the cumulative first live birth rate previously stated a conservative estimate. 11.7% of recipients had sibling deliveries from a single retrieval. Over 1/3 of the delivered recipients have remaining cryopreserved embryos and could pursue an additional pregnancy. Conclusion: These results suggest that pronuclear cryopreservation of all embryos in an oocyte donation cycle maintains good cumulative live birth rates, as well as chances for a sibling from a single retrieval. Recipients who must delay transfer can be reassured a high potential for live birth from their first donor retrieval.

Which Time Is It? A Suggestion for Unambiguous Nomenclature in Transplantation

We applaud the efforts of Bernat et al. (1Bernat JL D’Alessandro AM Port FK et al.Report of a national conference on donation after cardiac death.Am J Transplant. 2006; 6: 281-291.Crossref PubMed Scopus (452) Google Scholar) in trying to define and clarify the different phases of ischaemia during organ donation. Accurate recording of data relating to transplantation is essential for audit and research, and to provide a common language of transplantation yet 50 years after the first successful renal transplant, there is still confusion about the nomenclature of time points in transplantation. We propose that ‘ischaemic’ terminology needs further clarification and internationally approved definitions to standardize nomenclature and allow accurate comparisons of results. The suggested use of withdrawal phase (Phase I) and the acirculatory phase (Phase II) is sensible but this classification needs to be extended to clarify the remainder of donor organ ischaemia. What is the first warm ischaemic time? Is the second warm ischaemic time really warm? Is the ischaemic time inclusive or exclusive of the warm period? Indeed is the ischaemic time that point in time at which ischaemia occurred, or a duration of time, more accurately referred to as a time period? Figure 1 depicts a timeline of events that occur to a typical kidney from donor retrieval to implantation. At time point ‘A’ the donor becomes asystolic, and at point ‘B’ perfusion of the donor organs with cold preservation solution starts. In donation after cardiac death the time period ‘AB’ represents the warm ischaemic period prior to cooling. Currently this time period is variously called the first warm time or the warm ischaemic time. An unambiguous nomenclature would be the ‘Asystolic Warm Period’, reflecting the fact that during this time the organ remained in situ sustaining warm ischaemic damage. In a heart beating donor ‘AB’ is zero, i.e. there is no asystolic warm period. Time point ‘C’, commonly referred to as ‘time on ice’, should be taken as the time the organ is placed into cold storage, be that on a machine or in an ice box. The time taken to remove, store and pack the organ occurs between ‘B’ and ‘C’ and we think of this as ‘the organ recovery period’. At the recipient operation, the organ is removed from ice, time point ‘D’, and implanted in the recipient. The kidney is perfused with recipient blood at time point ‘E’. The period ‘DE’ is also known as the warm ischaemic time and the second warm time, although in reality the kidney is cold during this period and warms up relatively slowly in the 15–60 min, it takes to perform vascular anastomosis. For this reason we prefer to think of this time period as ‘the anastomosis period’. The total period of ischaemia is often referred to as the cold ischaemic time, and many surgeons discount the anastomosis period and/or asystolic period from this. The most useful time to quote is the total period of ischaemia, or ‘total ischaemic period’, representing the period ‘AE’. However, it should be noted that this aggregate value is less useful in predicting outcome than each of the contributing phases considered separately; for example, the asystolic warm period is more damaging per minute than the cold storage period. In conclusion, an internationally accepted nomenclature is needed to define donor organ ischaemic times that would provide accurate recording of events which will aid audit and research in transplantation.

Extracellular amino acid levels in the human liver during transplantation: a microdialysis study from donor to recipient

Using microdialysis, we have monitored extracellular levels of amino acids and related amines in the human liver at three stages of the transplantation procedure: donor retrieval, back table preparation and during 48 h post-implantation. By comparing the ratio of mean levels at the donor and back table stages, with the ratio between early (2-6 h) and late (43-48 h) post-reperfusion, these amines were classified into one of three groups. In one group, back table levels were markedly higher than during the donor stage, with levels declining over time post-reperfusion. A second group had much lower levels in the back table than during the donor phase, and post-reperfusion levels were either stable or increased over time. Concentrations of amino acids in the final group remained relatively constant at all stages. This study illustrates the value of microdialysis in providing organ-specific metabolic data that may indicate specific mechanisms of poor graft function.

O-195: Human uterus retrieval from a series of six multi-organ human donors

To report the results of a human uterus transplant project. To report the results of a series of human uterus procurements as part of routine multi-organ donor retrieval surgery within an existing organ donor network.

The Marginal Donor: A Single-Center Experience in Orthotopic Liver Transplantation

The use of marginal donors has become more common worldwide due to the sharp increase in recipients with a consequent shortage of suitable organs. The definition of “marginal donor” has not been reached by all centers. We herein analyzed our single-center experience over the last 3 years in liver transplantation (OLT) to evaluate the outcomes of using a high percentage of so-called “marginal donors”, according to the current classification from the National (Italian) Center of Transplantation (CNT). Among the 78 OLT performed in 77 patients from January 1, 2003 to October 31, 2005, donor livers were divided into three groups according to the CNT classification. We evaluated donor variables, cold ischemia time (CIT), warm ischemia time (WIT), MELD score, and length of hospital stay. Histologic graft steatosis was correlated with estimated steatosis by ultrasound. There were no differences among the three graft recipient groups concerning CIT, WIT, MELD score, and the length of hospital stay. Steatosis is indicated in all series as a definite variable for a higher risk of postoperative mortality. CIT is necessarily related to donor retrieval policy and organization. Donor age seemed also to be related to a possible increase in postoperative mortality, but there are significant variations in the definition of the age limit. We failed to observe a correlation between a higher mortality rate and any of the variables currently listed to define a “marginal donor.” A shorter CIT seemed to positively influence the role played by the other variables identifying a “marginal liver.” Finally, the use of HCV + or HBV + grafts did not lead to an increased mortality.