Liver transplantation using fatty livers: Always feasible?

Abstract

Steatotic liver grafts represent the most common type of "extended criteria" organs that have been introduced during the last two decades due to the disparity between liver transplant candidates and the number available organs. A precise definition and reliable and reproducible method for steatosis quantification is currently lacking and the potential influence of the chemical composition of hepatic lipids has not been addressed. In our view, these shortcomings appear to contribute significantly to the inconsistent results of studies reporting on graft steatosis and the outcome of liver transplantation. In this review, various definitions, prevalence and methods of quantification of liver steatosis will be covered. Ischemia/reperfusion injury of the steatotic liver and its consequences on post-transplant outcome will be discussed. Selection criteria for organ allocation and a number of emerging protective strategies are suggested.

Steatosis does not impair liver regeneration after partial hepatectomy

“…6 The increasing prevalence of NAFLD and in particular NASH in prospective donors diminishes the availability of organs in future. 7 Apparently 15-20% of the western population is obese, with up to 80-90% obese patients affected with NAFLD. Approximately 10-25% of these NAFLD patients develop NASH, whereas about 2-3% of the general population is estimated to have NASH.…”

Review on Liver Steatosis and its Impact on Liver Transplantation

“…Cirrhosis develops in up to 35% of those cases with a risk of liver failure or HCC. 11 Therefore, the increasing prevalence of NAFLD is expected to raise the number of liver transplantation (LT) candidates in the near future, and possibly become the most common indication for LT. 3 Risk factors: Given the tight association with MetS, the whole spectrum of NAFLD mostly occurs in patients with obesity (60-95%), T2DM (28-55%), and hyperlipidemia (27-92%). In a study of patients undergoing bariatric surgery, NAFLD was found in up to 95%, with fibrosis in 74%, and mild necroinflammation in 24% of cases.…”

“…However, several transplant programs consider a liver biopsy as mandatory before discarding a potential liver graft. 3 It was well recognized that the implantation of a donor's liver with severe fatty infiltration (>60%) is frequently associated with an increased incidence of postoperative complications. In the past, grafts with ≥30% fatty infiltration are not acceptable for transplantation.…”

“…2 Among the wide range of these ECD livers, hepatic steatosis is one of the most frequent disorders, which is mostly related to an increasing prevalence of fatty liver diseases. 3 …”

“…However, the quantitative methods provide information only on the total amount of fat, omitting any data on the chemical composition of hepatic lipids, novel objective tools such as measurement of the omega-6 and omega-3 FA levels in liver biopsy samples, may help prediction of the magnitude of reperfusion injury. 3 Importantly, other histopathological features should be carefully assessed in the presence of steatosis including inflammation, fibrosis, and ballooning degeneration. Different systems were developed for discrimination between simple steatosis and NASH, including:…”