Risk of extended criteria donors in hepatitis C virus-positive recipients.

1. An extended criteria donor is a donor who has certain characteristics that have an impact on the short-term and long-term outcomes of the recipient. 2. Grafts with reduced quality from extended criteria donors may show an increased sensitivity toward additional damaging events such as ischemia/reperfusion injury, acute rejection episodes, or recurrent hepatitis C. 3. Extended criteria donor features potentially having an impact on outcome in hepatitis C virus recipients include donor age, allograft steatosis, prolonged warm and cold ischemia times, and donation after cardiac death. 4. In hepatitis C virus-positive recipients, there is strong evidence showing an association between the use of grafts from older donors (>40-50 years) and increased fibrosis progression and reduced graft and patient survival. 5. A potential strategy to minimize the severity of recurrence is to optimize donor selection. Donor age limitations and exclusion of moderately to severely steatotic livers, in addition to minimization of ischemic times, may reduce the likelihood of preservation injury as well as biliary complications, which, in turn, have been shown to have an impact on survival for hepatitis C virus-positive recipients. 6. Although a donor graft biopsy is not required if an extended criteria donor is used, it is highly recommended when hepatitis C virus-positive donors, donation after cardiac death, or multiple extended criteria donor factors are involved.