Feasibility of using marginal liver grafts in living donor liver transplantation

Abstract

Liver transplantation (LT) is one of the most effective treatments for end-stage liver disease caused by related risk factors when liver resection is contraindicated. Additionally, despite the decrease in the prevalence of hepatitis B virus (HBV) over the past two decades, the absolute number of HBsAg-positive people has increased, leading to an increase in HBV-related liver cirrhosis and hepatocellular carcinoma. Consequently, a large demand exists for LT. While the wait time for patients on the donor list is, to some degree, shorter due to the development of living donor liver transplantation (LDLT), there is still a shortage of liver grafts. Furthermore, recipients often suffer from emergent conditions, such as liver dysfunction or even hepatic encephalopathy, which can lead to a limited choice in grafts. To expand the pool of available liver grafts, one option is the use of organs that were previously considered “unusable” by many, which are often labeled “marginal” organs. Many previous studies have reported on the possibilities of using marginal grafts in orthotopic LT; however, there is still a lack of discussion on this topic, especially regarding the feasibility of using marginal grafts in LDLT. Therefore, the present review aimed to summarize the feasibility of using marginal liver grafts for LDLT and discuss the possibility of expanding the application of these grafts.

Keywords: Marginal liver grafts; Living donor liver transplantation; Liver transplant waiting lists; Small-for-size grafts; Older donors; ABO-incompatible; Steatosis; Chronic hepatitis

Core tip: There are few reviews concerning the feasibility of using marginal liver grafts in living donor liver transplantation (LDLT). We reviewed more than 300 articles, summarized new findings, and confirmed that marginal grafts are a feasible option for expanding options for patients on liver transplant waiting lists in emergency situations in LDLT (e.g., liver failure or hepatic encephalopathy). However, such grafts place the recipients at greater risk for adverse events. Although some indispensable treatments are needed to address the deficiencies of these grafts, recipients can receive a favorable prognosis, similar to that of patients who receive standard liver grafts, under these treatments.