New Perspectives on the Use of Sub-Optimal Donor Livers

Liver transplantation is the therapy of choice for patients with end-stage liver disease. However, a shortage of donor organs remains a major obstacle to the widespread application of liver transplantation. To overcome this problem, transplant centers have developed strategies to expand the organ donor pool, including the routine use of sub-optimal donor livers. However, these have an increased risk of initial poor function or primary non-function that may cause greater risk of morbidity in the recipient. This chapter aims to describe the pathophysiological changes that may occur in sub-optimal donor livers, focusing on viral infections, since, after transplantation, infection of the graft is almost universal and can lead to chronic hepatitis, cirrhosis, and graft failure. The different experimental models as well as the clinical outcomes of the transplantation of sub-optimal donor livers with viral infections will be discussed. Such information may be useful to guide the design of better experimental models than those described to date as well as the effective use of sub-optimal livers with successful clinical application.