Criterios para Donantes Marginales de Hígado: Una Revisión
DOI:
https://doi.org/10.5281/zenodo.17933046Palabras clave:
Disfunción Primaria del Injerto, Selección del Donante, Supervivencia del InjertoResumen
Esta revisión tuvo como objetivo sintetizar los criterios que definen al donante marginal de hígado y evaluar sus implicaciones clínicas, mediante el análisis de 35 estudios publicados entre 2010 y 2025, recuperados de PubMed, Scopus, Web of Science y SciELO. Los resultados demostraron que la evaluación debe ser multifactorial, considerando criterios como la esteatosis macrovesicular (aceptable hasta el 30%, marginal entre 30–60% y restringida por encima del 60%), la edad avanzada del donante (>60–65 años, con emparejamiento por edad), la hipernatremia (≥155 mEq/L, corregible), el tiempo de isquemia fría (CIT >8–12 h, crítico para injertos marginales), la inestabilidad hemodinámica (distinguiendo estados refractarios y responsivos), las comorbilidades metabólicas (diabetes y obesidad como factores de riesgo independientes y aditivos) y las infecciones transmisibles (VHC y VHB anti-HBc positivo, manejables con antivirales y profilaxis). Se concluye que la utilización segura de estos órganos depende de un análisis integrado de riesgos y beneficios, de la selección cuidadosa de los receptores, de la adopción de estrategias mitigadoras y del apoyo de herramientas como el Donor Risk Index (DRI) y las tecnologías de perfusión mecánica, consolidando esta práctica como una opción segura y necesaria para ampliar la disponibilidad de órganos.
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Derechos de autor 2025 Gustavo Alves Rapassi, Kevin Lucas Barboza
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