Prevalence of Steatosis Hepatis in the Eurotransplant Region: Impact on Graft Acceptance Rates

Abstract

Due to the shortage of liver allografts and the rising prevalence of fatty liver disease in the general population, steatotic liver grafts are considered for transplantation. This condition is an important risk factor for the outcome after transplantation. We here analyze the characteristics of the donor pool offered to the Charité – Universitätsmedizin Berlin from 2010 to 2016 with respect to liver allograft nonacceptance and steatosis hepatis. Of the 2653 organs offered to our center, 19.9% (n=527) were accepted for transplantation, 58.8% (n=1561) were allocated to other centers, and 21.3% (n = 565) were eventually discarded from transplantation. In parallel to an increase of the incidence of steatosis hepatis in the donor pool from 20% in 2010 to 30% in 2016, the acceptance rates for steatotic organs increased in our center from 22.3% to 51.5% in 2016 (p < 0.001), with the majority (86.9%; p > 0.001) having less than 30% macrovesicular steatosis hepatis. However, by 2016, the number of canceled transplantations due to higher grades of steatosis hepatis had significantly increased from 14.7% (n = 15) to 63.6% (42; p < 0.001). The rising prevalence of steatosis hepatis in the donor pool has led to higher acceptance rates of steatotic allografts. Nonetheless, steatosis hepatis remains a predominant phenomenon in discarded organs necessitating future concepts such as organ reconditioning to increase graft utilization.

Nicht transplantierte Spenderorgane – eine bundesweite Auswertung aller Organangebote für die Lebertransplantation von 2010 bis 2018

“…B. Alter > 75 Jahre, makrovesikuläre Steatosis größer 60 %) [22,32]. Eventuelle Nachteile können jedoch ggf.…”

Pumping new life into old ideas: Preservation and rehabilitation of the liver using ex situ machine perfusion

“…One important example of this is the class of steatotic livers that is increasing in supply as a result of the obesity epidemic. Donor livers with significant steatotic content have decreased graft survival and an increased complication risk if transplanted and as a result, are often discarded or not pursued for procurement (Figure ) . Several centers have demonstrated the ability to decrease steatotic content and improve function in animal and discarded human liver models using a “defatting” cocktail .…”

Metabonomic Profile of Macrosteatotic Allografts for Orthotopic Liver Transplantation in Patients With Initial Poor Function: Mechanistic Investigation and Prognostic Prediction

“…Donated allograft quality directly affects the patient prognosis ( Feng et al, 2006 ; Flores and Asrani, 2017 ). Of which, macrosteatosis (MaS) was considered as an profound risk component for exceeded criteria donor (ECD), with positive impacts on inferior post-transplant survival and complications ( Spitzer et al, 2010 ; Vodkin and Kuo, 2017 ; Moosburner et al, 2018 ). Followed with rising prevalence of non-alcoholic fatty liver disease (NAFLD) in donor pool, more steatotic allografts are put into clinical application to solve the organ shortage under the pressure of increasing demands for liver transplantation.…”

“…Followed with rising prevalence of non-alcoholic fatty liver disease (NAFLD) in donor pool, more steatotic allografts are put into clinical application to solve the organ shortage under the pressure of increasing demands for liver transplantation. Undoubtably, the influence of allograft steatosis is becoming more and more prominent for increasing proportion applied in whole patient cohort ( Moosburner et al, 2018 ).…”

“…As one of prominent sign for extended criteria donor (ECD) livers, MaS was proved to be a risk predictor on adverse prognosis including severer liver injury, increased peri-operative complications, higher post-transplant mortality and graft loss ( De Graaf et al, 2012 ; Croome et al, 2019 ). In spite of controversies on acceptable safety cutoff ( Liu et al, 2019 ), donor MaS has become the major cause for organ discard and transplant cancelation in some LT centers ( Moosburner et al, 2018 ). Steatotic allografts deteriorate the function of transplanted liver by interaction with ischemia-reperfusion injury ( Gehrau et al, 2015 ; Dar et al, 2019 ).…”