Beggars Can?t Be Choosers: Deceased Donor Liver Transplantation Donor Pool Expansion - Our Experience

INTRODUCTION Liver transplantation is today the most sought after treatment for patients suffering from end stage liver disease. Unfortunately, organ donation has not kept pace with this rising demand, and a greater number of patients are dying each year while awaiting deceased donors. We are one of the leading centres in the country who are doing deceased donor liver transplantation (DDLT) regularly since 2007 and have changed our donor selection criteria to keep pace with this increasing demand. AIMS AND OBJECTIVES To review the changing pattern of donor demographic profile from Mar 2007 till Jul 2014 and see the outcome of deceased donor liver transplantation using marginal grafts. MATERIALS AND METHODS It is a retrospective study. Donor and recipient data for liver transplantation at our centre from Mar 2007 till Jul 2014 were analysed. Donors were labeled as marginal donors based on presence of certain adverse parameters. Incidence of early graft dysfunction and primary non function of graft were primary endpoints while major post operative complications were the secondary endpoints of the study. RESULTS A total of 52 retrievals were divided into 2 groups based on the presence of the adverse factors consisting of 38 marginal grafts and 14 ideal grafts for liver transplantation. While comparing the primary endpoints of the study it was noted that except early graft dysfunction ( EGD), other parameters like incidence of primary non functioning graft (PNF) and mortality were comparable in both the groups. However, the incidence of (EGD) was more in the group which received marginal grafts. The secondary endpoints of the study like incidence of major postoperative complications, hepatic artery thrombosis (HAT), portal vein thrombosis (PVT), hepatic venous outflow tract obstruction (HVOTO) and biliary strictures were similar in both the groups. There were a total of six deaths within 1 year of transplant, 3 in each group. The causes of mortality within 30 days post transplant were PNF, excessive bleeding and HAT. While sepsis was responsible for deaths after 30 days. CONCLUSION Marginal grafts do provide an immediate and significant expansion of the existing donor pool. Although beggars cant be choosers but by using any type of marginal donors we cannot compromise on the outcome of DDLT. So there is need for a prospective, multi centre data to define risk and delineate guidelines for ideal and marginal donors. The numbers in this study are small but it clearly indicates that marginal donors can be safely used in judiciously selected recipients for an acceptable outcome.