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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 18, 2015; 7(26): 2636-2647
Published online Nov 18, 2015. doi: 10.4254/wjh.v7.i26.2636
Strategies to optimize the use of marginal donors in liver transplantation
Daniele Pezzati, Davide Ghinolfi, Paolo De Simone, Emanuele Balzano, Franco Filipponi
Daniele Pezzati, Davide Ghinolfi, Paolo De Simone, Emanuele Balzano, Franco Filipponi, Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, 56124 Pisa, Italy
Author contributions: Pezzati D designed the study and wrote the manuscript; Ghinolfi D designed the study and wrote the manuscript; De Simone P, Balzano E and Filipponi F revised the manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest in relation to the submitted paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Davide Ghinolfi, MD, PhD, Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Via Paradisa, 2, 56124 Pisa, Italy. d.ghinolfi@ao-pisa.toscana.it
Telephone: +39-050-995421 Fax: +39-050-995420
Received: May 16, 2015
Peer-review started: May 20, 2015
First decision: July 25, 2015
Revised: October 4, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: November 18, 2015
Processing time: 186 Days and 4.4 Hours
Abstract

Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donation-transplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

Keywords: Liver transplantation, Extended criteria donors, Marginal donors, Results, Survival

Core tip: This review analyzes the donation-transplantation process when using extended criteria donors. Every step, from donor selection to transplantation, is discussed emphasizing experimental and clinical strategies that can lead to optimize results.