Clinical experience gained from the use of 120 steatotic donor livers for orthotopic liver transplantation

Abstract

Steatosis of the donor liver is known to impact on patient and allograft outcome after orthotopic liver transplantation (OLT). The aim of this study is to evaluate the effect of increasing grades of cadaveric donor liver steatosis on recipient outcome. Between January, 1986 and December, 2000, 120 OLTs were performed with 72 mild, 25 moderate, and 23 severe steatotic donor livers. Donors of steatotic livers were more likely to be older (P ‫؍‬ .001) and have died of intracerebral haemorrhage than donors of nonsteatotic livers. Initial poor graft function (IPF) was more common in donor livers with either moderate or severe steatosis than in donor livers with mild steatosis (P ‫؍‬ .03). Primary graft nonfunction (PNF) occurred in only 1 donor liver with severe steatosis. PGE1 (PGE1) usage was higher in recipients of donor livers with moderate or severe steatosis versus donor livers with mild steatosis (P ‫؍‬ .001). Allograft loss was greater at 1 year both in the moderate and severe (P ‫؍‬ .03) steatotic liver groups. Patient survival at 3 months and overall allograft survival both were impacted negatively by increasing grades of donor liver steatosis (P ‫؍‬ .02, P ‫؍‬ .03). Threemonth allograft survival was reduced in the steatotic donor livers if the donor was 50؉ years old (P ‫؍‬ .033). Recipient status at OLT (P ‫؍‬ .001) and donor steatosis (P ‫؍‬ .046) impacted on 30 day allograft survival (multivariate analysis). In conclusion, increasing grades of donor liver steatosis were associated with worse IPF and increased PGE1 usage. There was a negative impact of steatosis on both recipient and early allograft survival. (Liver Transpl 2003;9:500-505.)

Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

“…2,[15][16][17][18][19] This incidence is similar to the one observed for our SAP group. It is worth emphasizing that the prevalence of PNF, and consequently of graft/patient losses in the SAP group, are probably overestimated due to the small sample size.…”

“…2 On these grounds, we defined suboptimal livers as those with 1 major negative factor and/or at least 2 minor factors. This definition, based on several studies published in recent years, 2,[6][7][8][9][10][11][16][17][18][19][20] revealed a statistically significant impact on post-LT graft and patient survival rates in a retrospective analysis of our last 400 cases (our unpublished data).…”

“…In Moore et al, 13 however, patients receiving a graft more than 60 yr old (as the only major criterion) had a 20% prevalence of retransplantation and a 1-yr patient survival around 73%. Verran et al 18 has also shown that the sum of 2 suboptimal donor factors, such as donor age Ͼ50 yr and liver steatosis Ͼ30%, carried a 50% risk of graft loss within 3 months of LT. Approximately the same probability of graft loss was estimated by Cameron et al, 26 when 3 suboptimal donor factors (age Ͼ55 yr, intensive care unit stay Ͼ5 days, and ischemia time Ͼ10 hours) were simultaneously involved.…”

“…Verran et al 18 and Briceno et al 16,17 have also suggested using liver steatosis (which can only be determined precisely after histological examination) as a major criterion in defining suboptimal grafts. However, the pathologist's response is generally only available when the graft is brought back to the Center; i.e., after several hours of cold ischemia.…”

O doador marginal: experiência de um centro de transplante de fígado

“…Terceiro, o método de investigação da esteatose hepática escolhido não é o adequado e pode limitar as conclusões referentes a este importante parâmetro. Também é verdade que resultados referentes a transplante de fígado utilizando órgãos esteatóticos são controversos 28 . Quarto, a técnica de transplante hepático utilizada na maioria dos procedimentos foi a convencional sem desvio venovenoso no qual não foi observada influência negativa na evolução pós-operatória dos receptores que receberam enxertos marginais.…”