Transplantation of Suboptimal Donor Livers: Exploring the Boundaries

In the Netherlands, around 30% of all available donor livers are not used for transplantation. The reason for this is that these livers are considered to be of too low quality, which may result in an unacceptably high risk of graft failure after transplantation. The amount of discarded donor livers is larger than the number of patients that die while waiting for an organ. If only half of these previously declined donor livers could be safely used for transplantation, waiting list mortality could be minimalized.
This thesis focuses on enabling successful transplantation of suboptimal, high risk donor livers. Machine perfusion of donor livers has recently come into view to increase the number of transplantable donor livers, and has been extensively studied over the last years in the University Medical Center Groningen. In this thesis, the results are described of the first study worldwide in which previously declined donor livers were subjected to viability assessments. When these high risk donor livers met predefined criteria, they were subsequently transplanted. With this protocol, 69% of initially declined livers were actually transplanted, with a 100% patient and graft survival at 1 year. As all of these livers would not have been used before, this led to a sudden increase in the number of transplanted livers. Additionally, in this thesis a preclinical study is reported in which porcine and discarded human donor livers were safely preserved for up to 24 hours using machine perfusion. If confirmed in a prospective clinical study, this may potentially improve logistics for the transplant recipients as well as the transplant team.