Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index

Graaf, Esther L de; Kench, James G.; Dilworth, Pamela; Shackel, Nicholas; Strasser, Simone I.; Joseph, David; Pleass, Henry; Crawford, Michael; McCaughan, Geoffrey W.; Verran, Deborah

doi:10.1111/j.1440-1746.2011.06844.x

Cited by 149 publications

(166 citation statements)

References 25 publications

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“…The NAFLD is the leading cause of donor rejection in liver transplantation [37]. Experience from liver transplantation centers shows that steatosis [30 % in the donor liver is associated with a higher risk of primary nonfunction and graft initial poor function as compared to grafts with no or \30 % steatosis [38].…”

Section: Defining the Underlying Chronic Liver Diseasementioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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Section: Defining the Underlying Chronic Liver Diseasementioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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“…The long-term outcome is also The outcome of liver grafts with different grades of steatosis showed significantly lower patient and graft survival when grafts with steatosis >30% were used [7,9,10]. EAD was seen in 53% of grafts with moderate steatosis and in 73% of grafts with severe steatosis compared to 26% EAD in grafts with mild steatosis [7].…”

Section: I) Introductionmentioning

confidence: 99%

Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation

Nemes

Gámán

Polak

et al. 2016

Expert Review of Gastroenterology & Hepatology

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Extended criteria donors (ECDs) have an impact on early allograft dysfunction (EAD), biliary complications, relapse of hepatitis C virus (HCV), and survivals. Early allograft dysfunction was frequently seen in grafts with moderate and severe steatosis. Donors after cardiac death (DCD) have been associated with higher rates of graft failure and biliary complications compared to donors after brain death. Extended warm ischemia, reperfusion injury and endothelial activation trigger a cascade, leading to microvascular thrombosis, resulting in biliary necrosis, cholangitis, and graft failure. The risk of HCV recurrence increased by donor age, and associated with using moderately and severely steatotic grafts. With the administration of protease inhibitors sustained virological response was achieved in majority of the patients. Donor risk index and EC donor scores (DS) are reported to be useful, to assess the outcome. The 1-year survival rates were 87% and 40% respectively, for donors with a DS of 0 and 3. Graft survival was excellent up to a DS of 2, however a DS >2 should be avoided in higher-risk recipients. The 1, 3 and 5-year survival of DCD recipients was comparable to optimal donors. However ECDs had minor survival means of 85%, 78.6%, and 72.3%. The graft survival of split liver transplantation (SLT) was comparable to that of whole liver orthotopic liver transplantation. SLT was not regarded as an ECD factor in the MELD era any more. Full-right-full-left split liver transplantation has a significant advantage to extend the high quality donor pool. Hypothermic oxygenated machine perfusion can be applied clinically in DCD liver grafts. Feasibility and safety were confirmed. Reperfusion injury was also rare in machine perfused DCD livers. I) IntroductionAs discussed earlier, extended criteria donors are used widely. In this chapter a review is given about the impact of ECD on the outcome. Living related liver transplantation is discussed shortly, whether the partial grafts can still be regarded as ECD or not. Machine perfusion, as a possible management was also reviewed briefly. Outcome parameters are divided as possible complications, and survival results. Complications are listed as early graft dysfunction, biliary complications, HCV recurrence. Survival rates are summarized separately. Split, and living related LT discussed briefly, and finally the machine perfusion, as a possible future aspect is summarized. Silberhummer et al figured out the recipients' condition by the delta-MELD: as the difference between the MELD at transplantation and the MELD at listing. Patients with a both delta-MELD>1 and an ECD>2 together had a higher chance to develop EAD, and also significantly higher risk for mortality [3]. Others report a similar incidence of EAD, PNF, acute rejection, biliary complication and also that ECD had no significant effect on either ICU stay or duration of postOLT ventilation, and also the postOLT laboratory test, bleeding, biliary and vascular complication rates were similar in ECD and non-...

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“…Most transplant centers do not use grafts with more than 30% of macrovescicular steatosis. However, use of these latter grafts is suggested reducing cold storage within 6 h [44] . Steatotic livers show heightened sensitivity to I/R…”

Section: Steatosismentioning

confidence: 99%

Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

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Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index

Cited by 149 publications

References 25 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation

Strategies to optimize the use of marginal donors in liver transplantation

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