Use of Fatty Donor Liver Is Associated With Diminished Early Patient and Graft Survival

Abstract

It is well known that implantation of donor livers with severe fatty infiltration (>60%) is frequently associated with early hepatic dysfunction and an increased incidence of primary nonfunction after liver transplantation. The outcome of donor livers with less fatty infiltration has not been well defined. We, therefore, studied the outcome of 59 liver transplantations in which donor livers with up to 30% fat were used. Patient outcome was compared to a time-matched control group of 57 patients. The two groups were similar in terms of age, gender, preservation time, primary diagnosis, and UNOS status. We compared both groups with regard to 4-month and 2-year patient and graft survival. We also assessed the incidence of ischemic type biliary strictures and hepatic artery thrombosis, and evaluated the causes of graft loss in both groups. We found that use of donor livers with up to 30% fatty infiltration was associated with a significant decrease in 4-month graft survival (76% vs. 89%, P<0.05) and in 2-year patient survival (77% vs. 91%, P<0.05). Primary nonfunction and primary dysfunction formed the main cause of graft loss and mortality. Multivariate analysis showed that fatty infiltration is an independent predictive factor for outcome after transplantation. We conclude that liver allografts with up to 30% fat lead to diminished outcome after liver transplantation. However, this diminished outcome should be viewed with respect to the increasing mortality on the national waiting list.

Evaluation of potential liver donors: Limits imposed by donor variables in liver transplantation

“…†During ICU stay. 15,16 Conversely, the results of the ELTR clearly show that donor age over 65 years affects 1-and 5-year graft survival rate (73% and 55%, respectively). According to the last report of the ELTR, the incidence of primary nonfunction or severe graft dysfunction has remained the same during recent years.…”

Role of gender and race mismatch and graft failure in patients undergoing liver transplantation

“…15,[19][20][21][22] It is believed that these factors, usually classified as immunologic and nonimmunologic, also play a role in the transplantation of other organs. 3,4 Some studies have found that race is not a critical factor in liver transplantation.…”

“…Brooks et al, 21 in a study of the effect of donor and recipient gender on liver transplantation, found that female recipients had a 70% incidence of early rejection within six months after liver transplant compared with male recipients (60%; P Ͻ .039). They also found a decreased graft survival rate in male recipients of female livers.…”

The utility of marginal donors in liver transplantation

“…37,38,45,46 Clinically, recipients who receive grafts with moderate steatosis (Ͼ25% to 30%) have impaired early graft function in the first 3 days as reflected by a higher peak serum glutamic oxaloacetic transaminase, lower bile output, and increased intraoperative bleeding. Marsman et al 47 transplanted 59 livers with up to 30% fat and compared them to time-matched controls; the fatty liver group had a decreased 4-month graft survival and a decreased 2-year patient survival. In this study, graft survival was decreased if the recipient was more critical pretransplantation.…”