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World J Transl Med. Aug 12, 2014; 3(2): 58-68
Published online Aug 12, 2014. doi: 10.5528/wjtm.v3.i2.58
Liver transplantation with grafts obtained after cardiac death-current advances in mastering the challenge
Fateh Bazerbachi, Nazia Selzner, John B Seal, Markus Selzner
Fateh Bazerbachi, Department of Medicine, University of Minnesota, Minnesota 55455, United States
Nazia Selzner, Department of Medicine, University of Toronto, Multiorgan Transplant Program, Toronto General Hospital, ON M5G 2N2, Canada
John B Seal, Markus Selzner, Department of Surgery, University of Toronto, Multiorgan Transplant Program, Toronto General Hospital, ON M5G 2N2, Canada
Author contributions: Bazerbachi F and Selzner M designed the research and wrote the paper; Seal JB and Selzner M designed the research, wrote the paper and revised the paper.
Correspondence to: Markus Selzner, MD, Assistant Professor of Surgery, Department of Surgery, University of Toronto, Multiorgan Transplant Program, Toronto General Hospital, NCSB 11C-1244 585 University Avenue Toronto, ON M5G 2N2, Canada. markus.selzner@uhn.ca
Telephone: +1-416- 3405230 Fax: +1-416-3405242
Received: April 13, 2014
Revised: June 11, 2014
Accepted: July 17, 2014
Published online: August 12, 2014
Processing time: 136 Days and 19.1 Hours
Abstract

The scarcity of donor livers has increased the interest in donation after cardiac death (DCD) as an additional pool to expand the availability of organs. However, the initial results of liver transplantation with DCD grafts have been suboptimal due to an increased rate of complications, as well as decreased graft survival. These challenges have led to many developments in DCD donation outcome, as well as basic and translational research. In this article we review the unique characteristics of DCD donors, nuances of DCD organ procurement, the effect of prolonged warm and cold ischemia times, and discuss major studies that compared DCD to donation after brain death liver transplantation, in terms of outcomes and complications. We also review the different methods of donor treatment that has been applied to ameliorate DCD organ outcome, and we discuss the role of machine perfusion techniques in organ reconditioning. We discuss the two major perfusion models, namely, hypothermic machine perfusion and normothermic machine perfusion; we compare both methods, and delineate their major differences.

Keywords: Transplant hepatology; Liver transplantation; Organ donation; Extended criteria donors; Donation after cardiac death; Ex-vivo liver perfusion; Normothermic machine perfusion; Hypothermic machine perfusion

Core tip: There exists an increased need for liver grafts that currently exceed the availability of organs by a large margin. It is estimated that a third of the patients awaiting for transplantation will perish or become too ill due to the scarcity of grafts. This has led to a renewed interest in marginal organs as a potential pool. Most notably, donation after cardiac death livers has been targeted, and new strategies emerge to ameliorate their quality. Ex-vivo liver perfusion techniques could drastically change the paradigm of organ preservation, conditioning, and amelioration.