Impact of living donor liver with steatosis and idiopathic portal inflammation on clinical outcomes in pediatric liver transplantation: Beijing experience

Abstract

Background: To evaluate the impact of steatosis and/or idiopathic portal inflammation (IPI) in living donor livers on recipients' clinical outcomes. Methods:We assessed 305 qualified donor liver samples from June 2013 to December 2018. Donors and recipients' clinical characteristics, including follow-up data were retrieved. The graft and overall survival with/without steatosis or portal inflammation were compared by Kaplan-Meier analysis.Results: For living donors, the medium age of was 31.2 (28, 35.8) years old; liver histopathology showed macrovesicular steatosis: 0-5% 264/305 (86.6%) and 5-30% 41/305 (13.4%), IPI: no 220/305 (72.1%) and mild 85/305 (27.9%). For recipients, the medium age was 1.0 (0.6, 1.5) years old; the median pediatric-endstage-liver-disease score was 16 (5.0, 26.0) and medium follow-up time was 32.8 (24.8, 52.0) months. Biliary atresia (69.5%) was the main indication for liver transplantation (LT). Conclusions:The presence of steatosis and portal inflammation of the donor liver did not impact the clinical outcomes including transaminase or bilirubin normalization, short-/long-term complications and recipients' survival. However, recipients with high pediatric-end-stage-liver-disease score (>16) receiving donor liver with portal inflammation, but not steatosis, had trend negative effect on recipients' survival. In conclusion, donor livers with mild steatosis and portal inflammation were qualified for pediatric living donor LT. However, donor liver with mild portal inflammation would better not be allocated to recipients with high pediatric-end-stage-liver-disease score. This study provided new evidence in pediatric living donor liver allocation.

A contemporary analysis of 20,086 deceased donor liver biopsies

“…7 Limited information is available on the association of graft inflammation, measured as portal infiltration, on poorer recipient outcomes, however this factor has not been well accounted for in studies from the United States. 22,23 While our assessment of donor biopsy revealed similar findings to those done previously, it offers additional insight through stratification into risk categories that account for fibrosis, inflammation, and macrosteatosis. Previous reports have analyzed these factors independently, 7,9,12,20,21,24,25 however, no studies to date have simultaneously evaluated all three together.…”

“…demonstrated that macrosteatosis 21%–30% and >30% were not predictive of poorer 1‐year graft survival 7 . Limited information is available on the association of graft inflammation, measured as portal infiltration, on poorer recipient outcomes, however this factor has not been well accounted for in studies from the United States 22,23 …”

The role of innate immune cells in post-hepatectomy liver regeneration

“…Briefly, surgical injury during hepatectomy somehow activates innate immune cells, which in turn secrete cytokines and other paracrine factors to stimulate the growth of hepatocytes directly, to promote transdifferentiation or dedifferentiation of hepatocytes and cholangiocytes ( 5 ), or to help with regeneration-associated neovascularization ( 6 ). Tissue-resident innate immune cells, including Kupffer cells, has been demonstrated to derive interleukin-6 upon injury-specific niche signal and inflammation-mediated transcription, which triggers the dedifferentiation of mature hepatocytes into liver progenitor-like cells ( 7 ).…”

Qualifying the suitability of living donor livers for pediatric liver transplantation: are we doing the right thing?

“…The decline in donor organ quality is not likely limited to deceased donor livers, exemplified by the projected exponential increase in non-alcoholic fatty liver disease (NAFLD) ( 5 ). Recently, Zhao and colleagues reported in this journal on the relationship between steatosis and idiopathic portal inflammation (IPI) in living donor livers and the clinical outcomes in pediatric liver transplantation ( 6 ).…”

“…Zhao et al aimed to assess the prevalence of mild macrovesicular steatosis (5–30%) and mild IPI in donor livers which had been qualified for pLT and their association with the short- and long-term biochemical and clinical outcomes after pLT ( 6 ). The study was based on 305 in total 358 pLT procedures performed with a living donor in the Beijing Friendship Hospital between 2013 and 2018.…”