Liver transplantation using donor organs with markedly elevated liver enzymes: how far can we go?

Background: The disparity between the demand for solid organs and the current supply is a growing problem for patients with end-stage liver disease. To overcome organ shortage, extended criteria donor organs are also accepted for liver transplantation. Aims: We here unprecedentedly report the clinical course of patients receiving livers with markedly elevated liver enzymes. Methods: Between November 2007 and December 2010, 15 donor livers with markedly elevated liver enzymes [median aspartate aminotransferase (AST) 1400 (500-7538) U/l, median alanine aminotransferase (ALT) 1026 (308-9179) U/l] were offered to our transplant centre. Based on elaborate judgment, seven of these donor livers were rejected and eight donor livers were transplanted. Results: All eight transplanted patients showed a liver enzyme peak on the day of surgery (AST 2076 +/- 1808 U/l, ALT 1087 +/- 833U/l) and a statistically significant decrease from day 0 to day 7 post-liver transplantation. INR decreased and platelet count increased statistically significantly within 1 week after liver transplantation. The patients were discharged from the hospital 28 +/- 11 days after liver transplantation in good clinical condition. Conclusions: These data demonstrate that using donor livers with markedly elevated liver enzymes may be an acceptable option to expand the donor pool. Universal objective parameters for acceptance should be defined in future studies.