Evaluation of graft and recipient risk factors in liver transplantation

Donor–recipient matching is an important factor influencing the outcome of liver transplantation (LT), especially when, due to organ shortage, extended criteria donors (ECD) are used. Among donor risk factors, donor age has been associated with severe HCV recurrence after LT, and severe steatosis increases the risk of NAFLD after LT and impairs liver regeneration when partial liver is used. Grafts from HCV positive donors can be used (in absence of fibrosis) in HCV positive recipients; however, attention should be paid when donor age is over 50. Anti-HB core positive grafts are used in patients with HBsAg or anti-HBc patients with long term prophylaxis to prevent recurrence. The use of partial (living or cadaveric) livers is marginal in western countries but seems not to worsen prognosis. Decision whether to allocate ECD to sickest or healthiest recipients is still a matter of debate in terms of outcome and utility, therefore dedicated studies are needed.