Liver transplantation using donor organs with markedly elevated liver enzymes: how far can we go?

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http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02525.x/abstract

Liver transplantation using donor organs with markedly elevated liver enzymes:

how far can we go?

Radunz, s , Knut Nowak, Jürgen W. Treckmann, Fuat H. Saner,

Zoltan MathéArticle first published online: 5 APR 2011

DOI: 10.1111/j.1478-3231.2011.02525.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Early View (Online Version of Record published before inclusion in an issue)

Abstract

Background: The disparity between the demand for solid organs and the current

supply is a growing problem for patients with end-stage liver disease. To

overcome organ shortage, extended criteria donor organs are also accepted for

liver transplantation.

Aims: We here unprecedentedly report the clinical course of patients receiving

livers with markedly elevated liver enzymes.

Methods: Between November 2007 and December 2010, 15 donor livers with markedly

elevated liver enzymes [median aspartate aminotransferase (AST) 1400 (500–7538)

U/l, median alanine aminotransferase (ALT) 1026 (308–9179) U/l] were offered to

our transplant centre. Based on elaborate judgment, seven of these donor livers

were rejected and eight donor livers were transplanted.

Results: All eight transplanted patients showed a liver enzyme peak on the day

of surgery (AST 2076±1808 U/l, ALT 1087±833 U/l) and a statistically significant

decrease from day 0 to day 7 post-liver transplantation. INR decreased and

platelet count increased statistically significantly within 1 week after liver

transplantation. The patients were discharged from the hospital 28±11 days after

liver transplantation in good clinical condition.

Conclusions: These data demonstrate that using donor livers with markedly

elevated liver enzymes may be an acceptable option to expand the donor pool.

Universal objective parameters for acceptance should be defined in future

studies.