Liver Transplantation Using Steatotic Grafts

Jackson, Kyle R.; Long, Jane J.; Philosophe, Benjamin

doi:10.1002/cld.847

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…Decisively, the outcome is better once a proper selection of patients is performed [10]. However, many surgeons have shown an augmented risk for inferior post-transplant outcomes in case of donor livers with moderate or severe large droplet macrosteatosis (ld-MaS), although donor livers with small droplet macrosteatosis (sd-MaS) or mild (<30%) ld-MaS are safe for transplantation [41,42]. The combined analysis confirmed that the degree of steatosis in donors' livers was below 3.5% avoiding the possibility of having a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of seven gene signature for predicting HCV recurrence post-liver transplantation

Salum

El-Meguid

Abelhafez

et al. 2021

Journal of Genetic Engineering and Biotechnology

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Background Orthotropic liver transplantation (OLT) offers a therapeutic choice for hepatocellular carcinoma (HCC) patients. The poor outcome of liver transplantation is HCV recurrence. Several genome-wide associated studies (GWAS) have reported many genetic variants to be associated with HCV recurrence. Seven gene polymorphisms formed a cirrhosis risk score (CRS) signature that could be used to distinguish chronic HCV patients at high risk from those at low risk for cirrhosis in non-transplant patients. This study aims to examine the association of CRS score and other clinical parameters with the probability for HCC emergence and/or the rate of HCV recurrence following liver transplantation. Results Seven gene polymorphisms, forming the CRS, were genotyped by real-time PCR using allelic discrimination protocol in 199 end-stage liver disease patients (79 child A, 43 child B, and 77child C), comprising 106 patients who encountered liver transplantation. Recipient CRS scores were correlated with HCV recurrence (HCV-Rec) at the end of the third year after OLT. Around 81% (39) recipients with low steatosis (LS; < 3.5%) donor percentage revealed no HCV recurrence (non-Rec) (p<0.001). CRS score could distinguish between child A, child B, and child C only at the low-risk group. Among the HCV Rec group 27% (8/30), 40% (12/30), and 33% (10/30) fell into the high, moderate, and low CRS risk groups, respectively. Stepwise logistic regression evinced two features more likely to be seen in HCV-Rec patients: abnormal ALT [OR, 1.1; 95% CI, 1.02–1.2] and donor steatosis >3.5% [OR, 46.07; 95% CI, 1.5–1407.8]. Conclusions Accordingly, the CRS score seems to be less useful to predict HCV recurrence after OLT. ALT and donor steatosis (exceed 3.5%) can significantly promote the HCV recurrence post-OLT. Moreover, the combination of MMF and CNI positively heightens HCV recurrence.

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Section: Discussionmentioning

confidence: 99%

Evaluation of seven gene signature for predicting HCV recurrence post-liver transplantation

Salum

El-Meguid

Abelhafez

et al. 2021

Journal of Genetic Engineering and Biotechnology

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“…While declining the offer of a steatotic liver has been shown to increase an individual’s waiting list mortality [41], the unpredictable response of steatotic livers to reperfusion, with an increased severity of ischaemia‐reperfusion injury (IRI) and subsequently increased rates of PNF, EAD and post‐liver transplant acute kidney injury mean that there is an understandable reluctance to routinely transplant such livers [21,42]. As the demand for organ transplantation continues to remain high and the epidemic of obesity in the west is resulting in higher rates of steatosis in donor organs [43,44], we will inevitably need to implant more steatotic livers in the future. Others have shown that one possible solution to overcoming the excess risk of a steatotic organ is to allocate steatotic organs to ‘preferred recipients’ (defined as first‐time recipients with a MELD 15‐34, without primary biliary cirrhosis and not on life support prior to transplantation), as these recipients have no significant increase in mortality or graft loss when receiving steatotic compared to nonsteatotic livers [45].…”

Section: Discussionmentioning

confidence: 99%

Pilot study of a noninvasive real‐time optical backscatter probe in liver transplantation

et al. 2021

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Summary Transplantation of severely steatotic donor livers is associated with early allograft dysfunction and poorer graft survival. Histology remains the gold standard diagnostic of donor steatosis despite the lack of consensus definition and its subjective nature. In this prospective observational study of liver transplant patients, we demonstrate the feasibility of using a handheld optical backscatter probe to assess the degree of hepatic steatosis and correlate the backscatter readings with clinical outcomes. The probe is placed on the surface of the liver and emits red and near infrared light from the tip of the device and measures the amount of backscatter of light from liver tissue via two photodiodes. Measurement of optical backscatter (Mantel–Cox P < 0.0001) and histopathological scoring of macrovesicular steatosis (Mantel–Cox P = 0.046) were predictive of 5‐year graft survival. Recipients with early allograft dysfunction defined according to both Olthoff (P = 0.0067) and MEAF score (P = 0.0097) had significantly higher backscatter levels from the donor organ. Backscatter was predictive of graft loss (AUC 0.75, P = 0.0045). This study demonstrates the feasibility of real‐time measurement of optical backscatter in donor livers. Early results indicate readings correlate with steatosis and may give insight to graft outcomes such as early allograft dysfunction and graft loss.

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“…United Network for Organ Sharing region of transplant and year of transplant were included in all regression modeling, both of which have previously been shown to influence organ utilization and outcomes among highly steatotic organs. 9 , 14 All statistical analyses were performed using JMP Pro 14.1 software (SAS Institute Inc., Cary, NC). P values <0.05 were considered significant.…”

Section: Methodsmentioning

confidence: 99%

A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

Steggerda

Borja–Cacho

Brennan

et al. 2022

Transplantation Direct

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Liver Transplantation Using Steatotic Grafts

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/14-5-reading-jackson a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/14-5-interview-jackson the interview with the author

Cited by 12 publications

References 11 publications

Evaluation of seven gene signature for predicting HCV recurrence post-liver transplantation

Evaluation of seven gene signature for predicting HCV recurrence post-liver transplantation

Pilot study of a noninvasive real‐time optical backscatter probe in liver transplantation

A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

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