THE ROLE OF DYNAMIC AND MORPHOLOGICAL-STUDIES IN THE ASSESSMENT OF POTENTIAL LIVER-DONORS

In a prospective study, 66 donor livers were evaluated by monoethylgly cinexylidide (MEGX) dynamic clearance and semiquantitative scoring of pathological changes in liver biopsies. The median MEGX level in 63 do nors was 89 mcg/L (range 16-250 mcg/L); fifteen had MEGX levels < 50 m cg/L, 17 between 50 and 90 mcg/L, and 31 > 90 mcg/L. There were no cas es of primary nonfunction, and no deaths were related to poor graft fu nction. There was no statistically significant difference in peak aspa rtate aminotransferase (AST), day 5 AST, peak bilirubin, or lowest pro thrombin time among the 3 groups. Liver biopsies were assessed in 61 d onors: 33 (54%) were normal and 17 (28%) showed mild, 8 (13%) showed m oderate, and 3 (5%) showed severe steatosis. Postperfusion biopsy asse ssing the extent of preservation injury was essentially normal or show ed minimal change in 16 (26%), mild change in 29 (48%), moderate in 13 (21%) and severe abnormalities in 3 (5%). The latter 3 biopsies all h ad severe steatosis. There was no significant difference in early graf t function or outcome between moderate/severe groups and normal/minima l groups, although the former had a higher peak AST (P<0.02) and peak bilirubin (P<0.004). This detailed prospective analysis suggests that MEGX and the morphological studies may assist in the assessment of pot ential liver donors but they do not provide a basis on which grafts sh ould be discarded.