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World J Gastroenterol. Aug 21, 2014; 20(31): 10691-10702
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10691
Using old liver grafts for liver transplantation: Where are the limits?
Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González
Carlos Jiménez-Romero, Oscar Caso Maestro, Félix Cambra Molero, Iago Justo Alonso, Cristina Alegre Torrado, Alejandro Manrique Municio, Jorge Calvo Pulido, Carmelo Loinaz Segurola, Enrique Moreno González, Service of General and Digestive Surgery and Abdominal Organ Transplantation, “Doce de Octubre”, University Hospital, 28041 Madrid, Spain
Author contributions: All the authors contributed to this manuscript.
Correspondence to: Carlos Jiménez-Romero MD, PhD, FACS, Service of General and Digestive Surgery and Abdominal Organ Transplantation, “Doce de Octubre”, University Hospital, UCM, Ctra de Andalucía km 5, 28041 Madrid, Spain. carlos.jimenez@inforboe.es
Telephone: +34-91-3908077 Fax: +34-91-3908077
Received: September 27, 2013
Revised: December 16, 2013
Accepted: April 1, 2014
Published online: August 21, 2014
Processing time: 326 Days and 21.7 Hours
Abstract

The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.

Keywords: Old liver donors; Liver transplantation; Aging liver; Liver graft; Liver disease; Aging; Donor management; Septuagenarian donors; Octogenarian donors