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World J Transplant. Jun 24, 2016; 6(2): 314-320
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.314
Potential approaches to improve the outcomes of donation after cardiac death liver grafts
Paria Mahboub, Adel Bozorgzadeh, Paulo N Martins
Paria Mahboub, Department of Surgery, Groningen Transplant Center, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
Paria Mahboub, Adel Bozorgzadeh, Paulo N Martins, Department of Surgery, Division of Transplantation, University of Massachusetts, Worcester, MA 01655, United States
Author contributions: Mahboub P wrote the manuscript; Bozorgzadeh A and Martins PN contributed to writing the manuscript.
Supported by University of Massachusetts (FDSP grant to Paulo N Martins).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paulo N Martins, MD, PhD, Department of Surgery, Division of Transplantation, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, United States. paulo.martins@umassmemorial.org
Telephone: +1-508-3342023
Received: July 18, 2015
Peer-review started: July 19, 2015
First decision: September 17, 2015
Revised: December 24, 2015
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: June 24, 2016
Abstract

There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft’s for transplantation, improve the outcomes, and decrease the mortality on the waiting list.

Keywords: Biliarycomplications, Donation after cardiac death, Organ preservation methods

Core tip: As the demand for more organs increases, the transplant community searches for new approaches to expand the pool of organs. Recently developed methods to improve the condition of donation after cardiac death (DCD) livers look promising. During the past decade, ex vivo machine perfusion method has demonstrated positive results and it is considered as a new potential preservation method for DCD organs. This paper provides an overview of the attempts to ameliorate the quality of DCD liver grafts and transplant outcomes by improving preservation techniques.