A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

Abstract

Supplemental Digital Content is available in the text.

Steatotic Donor Transplant Livers: Preservation Strategies to Mitigate against Ischaemia-Reperfusion Injury

“…Sd-MaS is known to increase during preservation and at reperfusion and is a transient short-lived process that indicates both liver stress/injury and recovery/regeneration from these processes. In general, ≥30% Sd-MaS is considered to be safe with no overall impact on graft survival [14,15]. However, the presence of moderate (30-60%) or severe (≥60%) Ld-MaS is associated with reduced tolerance to static cold storage (SCS, the gold standard for organ preservation) and an increased sensitivity to the process of ischaemia-reperfusion injury (IRI), clinically manifesting as post-reperfusion syndrome (PRS), EAD, requirement for renal replacement therapy (RRT), and reduced graft/patient survival [11,12].…”

“…However, the presence of moderate (30-60%) or severe (≥60%) Ld-MaS is associated with reduced tolerance to static cold storage (SCS, the gold standard for organ preservation) and an increased sensitivity to the process of ischaemia-reperfusion injury (IRI), clinically manifesting as post-reperfusion syndrome (PRS), EAD, requirement for renal replacement therapy (RRT), and reduced graft/patient survival [11,12]. Ld-MaS is widely acknowledged to be a negative prognostic factor in models that predict graft/patient survival following LT [15,16]. Consequently, this reflects the reservation and caution of liver transplant units in utilising donor livers with evidence of moderate-severe steatosis [13,[17][18][19][20] and in the UK, donor livers with evidence of HS account for 39% of organ discards [21].…”

How to Preserve Steatotic Liver Grafts for Transplantation

“…The utilization of livers with moderate MaS has been associated with an increased rate of early allograft dysfunction, biliary complications, and decreased graft survival, whereas severe MaS has been linked to postoperative poor function, need for renal replacement therapy, and inferior patient and graft survival [ 5 , 6 ]. Consequently, MaS has been included as a negative prognostic factor in models predicting post-LT patient and graft survival [ 14 , 15 ]. The high risk associated with the use of severely steatotic livers is reflected by the very low number of patients in the series reporting their use [ 7 , 16 , 17 , 18 , 19 ], suggesting that, despite some encouraging results that have been reported, these grafts are generally approached with extreme caution and most frequently discarded.…”