The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis

Croome, Kristopher P.; Lee, David D.; Croome, Sarah; Chadha, Ritu; Livingston, David H.; Abader, Peter; Keaveny, Andrew P.; Taner, C. Burcin

doi:10.1111/ajt.15330

Cited by 57 publications

(70 citation statements)

References 46 publications

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“…We demonstrated that if the recipients are able to tolerate the perioperative events related to steatotic grafts, then the overall outcome is similar to outcomes with nonmacrosteatotic grafts. (15)…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

et al. 2019

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Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait‐list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End‐Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

et al. 2019

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“…Macrovesicular steatosis was defined as a single vacuole larger than the nucleus, replacing most of the cytoplasm in the hepatocytes and displacing the nucleus to the cell membrane. Reference slides with the percentage of macrosteatosis can be seen in our previous publication . Microvesicular steatosis involves small lipid vesicles without nuclear displacement, causing a foamy appearance of the cytoplasm .…”

Section: Methodsmentioning

confidence: 99%

“…Reference slides with the percentage of macrosteatosis can be seen in our previous publication. (15) Microvesicular steatosis involves small lipid vesicles without nuclear displacement, causing a foamy appearance of the cytoplasm. (16) Hepatic microsteatosis was characterized quantitatively by the percentage of hepatocytes containing lipid droplets.…”

Section: Methodsmentioning

confidence: 99%

Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

et al. 2019

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It has been suggested that microsteatosis does not negatively impact graft survival following liver transplantation (LT). The present study represents the largest series on donor livers with significant microsteatosis and investigates the impact of microsteatosis on perioperative factors such as postreperfusion syndrome (PRS), early allograft dysfunction (EAD), and postoperative renal dysfunction. Clinical outcomes of all patients undergoing LT with donor livers with isolated microsteatosis (≥30%; n = 239) between 2000 and 2017 were compared with a propensity score–matched cohort of patients undergoing LT with donor livers with no steatosis (n = 239). Patients in the microsteatosis group had a higher rate of PRS (33.1% versus 24.2%; P = 0.03), EAD (38.2% versus 23.0%; P < 0.001), and continuous renal replacement therapy (CRRT) requirement following LT (10.9% versus 3.6%; P = 0.002) than the no steatosis group. No difference in patient (P = 0.33) or graft survival (P = 0.18) was observed between the 2 groups. On multivariate regression, livers with microsteatosis had an increased risk of graft loss with retransplant recipients (hazard ratio [HR], 1.59; P < 0.001), increasing Model for End‐Stage Liver Disease (MELD) score (HR, 1.13; P = 0.01), and organs from donation after circulatory death donors (HR, 1.46; P = 0.003). In conclusion, recipients of donor livers with significant microsteatosis are at an increased risk of PRS, EAD, and postoperative renal dysfunction requiring CRRT. Livers with significant microsteatosis should be avoided in retransplant recipients and in recipients with high biological MELD scores. Once appropriately selected recipients of these livers are able to overcome the initial perioperative implications of using these donor livers, longterm patient and graft survival is similar to recipients receiving grafts with no steatosis.

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“…(3) Selecting a recipient that can tolerate early allograft dysfunction (EAD): Previous studies have demonstrated that EAD has been shown to have a baseline rate of 23 to 27% in generalized cohorts of patients undergoing LT. [42][43][44] With DCD LT, the rate of EAD is significantly higher (34-40%). 45,46 Recipients who have high Model for End-Staged Liver Disease scores and are in the ICU, recipients with a significant cardiac history, or recipients with compromised renal function may not be ideal candidates since they may not be able to tolerate EAD.…”

Section: Appropriate Recipient Selectionmentioning

confidence: 99%

Donation after Circulatory Death: Potential Mechanisms of Injury and Preventative Strategies

Croome

2020

Semin Liver Dis

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Donation after circulatory death (DCD) donors represent a potential means to help address the disparity between the number of patients awaiting liver transplantation (LT) and the availability of donor livers. While initial enthusiasm for DCD LT was high in the early 2000s, early reports of high rates of biliary complications and inferior graft survival resulted in reluctance among many transplant centers to use DCD liver grafts. As with all innovations in transplant practice, there is undoubtedly a learning curve associated with the optimal utilization of liver grafts from DCD donors. More contemporary data has demonstrated that results with DCD LT are improving and the number of DCD LT performed annually has been steadily increasing. In this concise review, potential mechanisms of injury for DCD livers are discussed along with strategies that have been employed in clinical practice to improve DCD LT outcomes.

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The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis

Cited by 57 publications

References 46 publications

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

Donation after Circulatory Death: Potential Mechanisms of Injury and Preventative Strategies

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