Donor Liver Dysfunction: Application of a New Scoring System to Identify the Marginal Donor

Ferraz-Neto, Ben Hur; Zurstrassen, M.P.V.C.; Hidalgo, R.; Fonseca, Luís; Motta, Tommaso Di; Pandullo, Fernando Luis; Rezende, Marcelo Bruno de; Meira-Filho, S.P.; Sá, João Roberto de; Afonso, R.C.

doi:10.1016/j.transproceed.2007.07.034

Cited by 11 publications

(12 citation statements)

References 10 publications

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“…[2][3][4] In other reports on large series of pretransplant liver biopsies, the method used for the histological analysis was not specified. 5,6 The frozen-section approach implies lower histopathological definition but allows a rapid histological examination. It also appears to be preferable for cadaveric donors because it implies a substantial reduction of the cold ischemia time in comparison with routine histopathological processing.…”

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Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

et al. 2009

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Histological quality assessment of donated livers is a key factor for extending the cadaveric donor pool for liver transplantation. We retrospectively compared frozen-section analysis with routine histological permanent slides and the outcomes of grafts in liver biopsies from 294 candidate donors. The concordance coefficient of agreement between frozen-section analysis and routine histological analysis was very good for macrosteatosis ( ‫؍‬ 0.934), microsteatosis ( ‫؍‬ 0.828), and total steatosis ( ‫؍‬ 0.814). The correlation between the mean amounts of macrosteatosis, microsteatosis, and total steatosis in frozen and permanent sections was also significant (P < 0.001, Spearman's test). Macrosteatosis and microsteatosis were overestimated to >30% in 4 of 32 cases (12.5%) and in 23 of 62 cases (37.1%), respectively. The only 2 histological parameters of frozen sections able to predict graft dysfunction within 7 days of transplantation were macrosteatosis and total steatosis (P ‫؍‬ 0.018 and P ‫؍‬ 0.015, respectively, Mann-Whitney test). None of the other histopathological features evaluated in frozen sections, including portal inflammation, lobular necrosis, myointimal thickening, biliocyte regression, cholestasis, hepatocellular polymorphism, lipofuscin storage, and fibrous septa, were significantly correlated with the graft outcome. The frozen-section histological evaluation of biopsies from cadaveric liver donors is an accurate, time-effective, and predictive method for the assessment of graft suitability.

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Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

et al. 2009

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“…This shortage of suitable donor livers has led to the increasing use of so-called "marginal donors" (1-3). Transplantation of "marginal" donor livers is associated with an increased risk of primary nonfunction, increased retransplantation rates, and increased recipient morbidity and mortality (4,5). Liver steatosis (hepatic lipid accumulation) is a primary factor in determining the suitability of donor livers for transplantation, since donor liver steatosis is associated with a significantly increased risk of primary graft nonfunction (6 -8).…”

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confidence: 99%

“…Currently, donor livers with Ͼ30% fat content are considered to have a prohibitively high rate of primary nonfunction and ϳ25% of donor livers are rejected due to steatosis. The pathogenic mechanisms for graft failure following transplantation of steatotic livers are incompletely understood, but there is evidence that steatotic livers are more susceptible to ischemia reperfusion injury (IRI) 4 (6 -8). IRI is a major and unavoidable clinical problem associated with liver transplantation, whether donor livers are lean or steatotic.…”

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A Role for Complement in the Enhanced Susceptibility of Steatotic Livers to Ischemia and Reperfusion Injury

Atkinson²,

Evans

et al. 2009

The Journal of Immunology

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Hepatic steatosis typically renders the donor organ unusable, as donor organs with >30% steatosis are more likely to develop graft failure. The mechanisms leading to failure are not well defined, but steatosis enhances hepatic susceptibility to ischemia reperfusion injury (IRI). We investigated the role of complement in hepatic IRI in lean and steatotic (diet-induced) mice. Steatotic mice were significantly more susceptible to total warm hepatic IRI than lean mice as determined by serum alanine aminotransferase, histopathologically assessed damage, and 24-h survival. C3 deficiency protected both lean and steatotic mice from IRI, as determined by all measured outcomes. Furthermore, treatment of wild-type mice with the complement inhibitor CR2-Crry provided protection equivalent to that seen in C3-deficient mice. Importantly, although steatotic livers were much more susceptible to IRI than lean livers, by most measures there was no statistical difference between the level of IRI to steatotic or lean livers when complement was inhibited. To investigate the clinical relevance of these findings in the context of transplantation, we treated recipients of lean or steatotic liver grafts with saline or CR2-Crry. There was a marked reduction in graft inflammation and injury and significantly improved 7-day survival in CR2-Crry-treated recipients of either lean or steatotic grafts. These data indicate that complement plays a key role in the enhanced susceptibility of steatotic livers to IRI and suggest that complement inhibition represents a potential strategy to reduce the donor shortage by allowing the more routine use of marginal steatotic donor livers.

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“…Primeiro, devido a dramática escassez de órgãos e a alta mortalidade na lista de espera, a maioria dos transplantes realizados no Serviço de Transplante Hepático do Hospital Universitário Oswaldo Cruz utilizou enxertos de doadores marginais 25,26,27 . Segundo, até junho de 2006, a alocação dos fígados de doadores cadáver obedecia ao critério cronológico.…”

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

Fonseca-Neto¹,

Miranda²,

Sabat³

et al. 2008

ABCD, arq. bras. cir. dig.

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InTRODUÇÃOLesão por isquemia e reperfusão é processo inevitável que culmina com morte celular e afeta muito a função do enxerto após o transplante de fígado . Em seguida à restauração do fluxo sangüíneo, o fígado é submetido a lesão adicional mais grave do que a induzida pela isquemia . Disfunção primária e a sua forma mais grave, a falência primária, são conseqüências da lesão de isquemia e reperfusão e representam importante causa no aumento da morbidade e mortalidade após transplante de fígado 3 .O uso de enxertos marginais tem sido solução aceita pela escassez de órgãos para transplante e o seu uso tornou-se muito comum em todo mundo. A literatura vem mostrando efetividade desses órgãos e seus resultados no transplante de fígado 4,5,6 .O objetivo deste estudo é apresentar a experiência com transplante de fígado utilizando órgãos de doadores marginais em um centro hospitalar. ABCDDV/580

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Donor Liver Dysfunction: Application of a New Scoring System to Identify the Marginal Donor

Cited by 11 publications

References 10 publications

Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

A Role for Complement in the Enhanced Susceptibility of Steatotic Livers to Ischemia and Reperfusion Injury

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

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