Use of steatotic graft in living-donor liver transplantation

Soejima, Yuji; Shimada, Mitsuo; Suehiro, Taketoshi; Kishikawa, Keiji; Yoshizumi, Tomoharu; Hashimoto, Koji; Minagawa, Ryosuke; Hiroshige, Shoji; Terashi, Takahiro; Ninomiya, Mizuki; Shiotani, Satoko; Harada, Noboru; Sugimachi, Keizō

doi:10.1097/01.tp.0000071205.52835.a4

Cited by 117 publications

(92 citation statements)

References 19 publications

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“…Most of the previous studies on the quality assessment of donated liver tissue were performed with a routine histopathological procedure on organs from both living and cadaveric donors. [2][3][4] In other reports on large series of pretransplant liver biopsies, the method used for the histological analysis was not specified. 5,6 The frozen-section approach implies lower histopathological definition but allows a rapid histological examination.…”

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confidence: 99%

Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

et al. 2009

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Histological quality assessment of donated livers is a key factor for extending the cadaveric donor pool for liver transplantation. We retrospectively compared frozen-section analysis with routine histological permanent slides and the outcomes of grafts in liver biopsies from 294 candidate donors. The concordance coefficient of agreement between frozen-section analysis and routine histological analysis was very good for macrosteatosis ( ‫؍‬ 0.934), microsteatosis ( ‫؍‬ 0.828), and total steatosis ( ‫؍‬ 0.814). The correlation between the mean amounts of macrosteatosis, microsteatosis, and total steatosis in frozen and permanent sections was also significant (P < 0.001, Spearman's test). Macrosteatosis and microsteatosis were overestimated to >30% in 4 of 32 cases (12.5%) and in 23 of 62 cases (37.1%), respectively. The only 2 histological parameters of frozen sections able to predict graft dysfunction within 7 days of transplantation were macrosteatosis and total steatosis (P ‫؍‬ 0.018 and P ‫؍‬ 0.015, respectively, Mann-Whitney test). None of the other histopathological features evaluated in frozen sections, including portal inflammation, lobular necrosis, myointimal thickening, biliocyte regression, cholestasis, hepatocellular polymorphism, lipofuscin storage, and fibrous septa, were significantly correlated with the graft outcome. The frozen-section histological evaluation of biopsies from cadaveric liver donors is an accurate, time-effective, and predictive method for the assessment of graft suitability.

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Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantation

et al. 2009

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“…However, there are little clear parameters to demonstrate the limits of the fatty liver. It was reported that in the LDLT the fatty liver was acceptable to the moderate grade of macrovesicular steatosis (20-50% of macrovesicular steatosis) [18]. However, recent research has showed that the breakdown of sinusoidal reconstitution occurs in the liver regeneration process of a fatty liver [19]; therefore, the fatty liver donor should be avoided in the case of the small-for-size graft.…”

Section: Donor Fatty Livermentioning

confidence: 99%

Donor Safety in Live-Related Liver Transplantation

Wakade

Mathur

2011

Indian J Surg

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Living donor liver transplantation (LDLT), since its advent in late 1980's and early 1990's, has rapidly increased especially in countries like Japan, Korea and India where cadaveric programmes are not as well established as in the western world. The main advantage of LDLT is the availability of an organ in the elective setting in the course of a progressive liver disease. This is most applicable in patients with Cirrhosis and Hepatocellular carcinoma. LDLT, from the donor's perspective does carry a risk of not only morbidity but mortality. To date the surgical mortality risk is estimated at 0.1% for left lateral donation and 0.5% for right liver donation. Donor mortality has been reported from various centres in India. There are reports of complications like Hepatic artery thrombosis, portal vein thrombosis and especially biliary leaks and strictures occurring at a significantly increased frequency after living as compared to deceased donor liver transplantation. The key to reduce donor morbidity and mortality is meticulous donor selection and thorough donor work up. In the present study we will analyse the factors that contributed to donor mortality and morbidity and prepare a detailed work up plan, intraoperative and post-operative strategy to reduce donor morbidity and mortality.

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“…66 However, MiS is frequently regarded as a mild and reversible condition and is usually disregarded as a risk factor for graft dysfunction, it has been established that graft MiS is an independent factor influencing the early graft function (EGD). 61 Cieslak et al 67 observed that a 12% increase in MiS was equivalent to a 50% increased risk for graft dysfunction. 67 MiS may develop because of severe and prolonged inhibition of mitochondrial β-oxidation of FAs during preservation-reperfusion injury.…”

Section: Impact Of Steatosis On Ltmentioning

confidence: 99%

“…69 On the contrary and despite the graft dysfunction risk, the use of livers exhibiting MiS does not decrease graft or patient survival rates. 61 On the other hand, the composition of hepatic lipids and particularly thromboxane A 2 levels are considered the principal modulators of I/R injury in the steatotic livers, while the size and morphology of lipid droplets are insignificant. 70 Other potential mechanisms that have been proposed include Kupffer cell dysfunction, 71 more lipid peroxidation, 72,73 more exuberant pro-inflammatory responses, including increased release of pro-inflammatory mediators such as TNF-α, 74 and impaired leukocyte adhesion.…”

Section: Impact Of Steatosis On Ltmentioning

confidence: 99%

“…3 However, the critical shortage of organ donors, especially in countries such as middle-and far-eastern countries, where cadaveric donors are almost less available, often mandates the use of such grafts with different degree of steatosis. 61 It has been postulated that steatotic livers are more sensitive and less tolerant to ischemia-reperfusion (I/R) injury, leading to worse clinical outcomes. If severe, I/R injury can lead to liver failure and death.…”

Section: Impact Of Steatosis On Ltmentioning

confidence: 99%

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