Matching donor to recipient in liver transplantation: Relevance in clinical practice

Abstract

Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor, graft and recipient factors. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation. A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age, gender, ethnicity, viral serology; graft factors such as size and quality, recipient factors such as age, size, gender and transplant factors such as major or minor blood group incompatibility and immunological factors. We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors’ clinical experience. Multiple donor and recipient factors impact graft survival after liver transplantation. Appropriate matching based on donor-organ-recipient variables, modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.

Keywords: Liver transplantation, Donor-recipient mismatch, Immunological mismatch, Viral serology mismatch

Core tip: Multiple donor and recipient factors impact graft survival after liver transplantation. In addition, interaction between donor, graft and recipient factors may significantly affect management and outcomes. Appropriate matching based on donor-organ-recipient variables can avoid wastage of liver grafts, improve outcomes and decrease graft loss. Modification of surgical techniques and innovative peri-transplant strategies can expand the donor pool by utilizing grafts from marginal donors that are traditionally turned down.