Strategies to Improve Outcome after Transplantation of Extended Criteria Donor Livers

To reduce the current imbalance between available donor livers and patients waiting for a new liver graft, suboptimal donor livers are increasingly accepted for liver transplantation. Examples of suboptimal donor livers are livers derived from elderly donors or donors with a fatty liver due to overweight. Unfortunately, these suboptimal donor livers are more prone for the period of ischemia, which occurs when the donor liver is transported between the donation and transplantation hospital. Because of this higher vulnerability for ischemia, suboptimal donor livers are related to a higher degree of tissue injury and subsequently poorer postoperative outcomes. The subject of Andrie Westerkamp’s PhD thesis was to examine different strategies to improve the outcome after transplantation of suboptimal donor livers. First, the PhD candidate concluded that a short cold ischemia time is necessary when elderly and fatty donor livers are accepted for transplantation. Nowadays, no methods are available that can examine the degree of fat quickly and accurately in the short time frame of a donation procedure. Westerkamp and co-workers demonstrated that spectrometry is able to measure the degree of liver fat very accurately and in-real time. Finally, Westerkamp showed that machine perfusion, a new potential preservation technique, improves the quality of suboptimal donor livers compared to the current preservation method, static cold storage. Moreover, the PhD candidate concluded that independent of the perfusion temperature, machine perfusion is also able to reduce the degree of ischemic injury to the bile ducts