Short- and Long-term Outcomes After Steatotic Liver Transplantation

Department of Surgery, Washington University School of Medicine, 660 S Euclid Avenue, St Louis, MO 63110, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.93). 07/2010; 145(7):653-60. DOI: 10.1001/archsurg.2010.119
Source: PubMed


To determine if the use of steatotic grafts adversely affects outcomes in liver transplantation.
A retrospective review of a prospectively maintained database.
A single center.
Four hundred ninety adults who underwent liver transplantation from January 1, 2002, to December 31, 2008, at a single center. Graft biopsies were available in 310 (63.3%) cases. Grafts were classified based on amount of macrovesicular steatosis: 5% or less (n = 222), more than 5% to less than 35% (n = 66), and 35% or more (n = 22).
Recipient demographics, Model for End-Stage Liver Disease (MELD) score, patient/graft survival, complications, transfusion rates, and liver function test results.
One-, 3-, and 5-year patient and graft survivals, respectively, were similar (90.38%, 84.7%, and 74.4%, respectively, P = .3; and 88.7%, 82.5%, and 73.3%, respectively, P = .15). Median follow-up was 25 months. Recipient age, sex, body mass index, laboratory MELD score, and ischemia times were similar among all groups. Packed red blood cell (3 vs 8 U, P < .001), fresh frozen plasma (2 vs 4 U, P = .007), and cryoprecipitate transfusion rates were significantly increased in grafts with 35% or more steatosis. Intensive care unit (5 vs 11 days, P = .02) and hospital (11 vs 21 days, P < .001) stay was also increased in those with grafts with 35% or more steatosis compared with those with 5% or less steatosis. The grafts with 35% or more steatosis had higher transaminase peaks and longer times for bilirubin to normalize (P < .001).
Use of carefully selected steatotic grafts was not associated with higher rates of primary nonfunction or poorer outcomes. However, the use of steatotic grafts is associated with increased resource use in the perioperative period.

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    • "Spitzer et al. [30] concluded that steatosis should be added to the DRI, when dealing with a high-risk donor. However, objective evaluation of the range of steatosis, either as macro- or microvesicular steatosis, is not standardized so far subjective to some degree [29]. We believe that routine donor biopsy evaluation may enable the design of more powerful and robust donor risk scores. "
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    ABSTRACT: Liver transplantation is the only life-saving therapeutic option for end-stage liver disease. Progressive donor organ shortage and declining donor organ quality justify the evaluation of the leverage of the Donor-Risk-Index, which was recently adjusted to the Eurotransplant community's requirements (ET-DRI). We analysed the prognostic value of the ET-DRI for the prediction of outcome after liver transplantation in our center within the Eurotransplant community. 291 consecutive adult liver transplants were analysed in a single centre study with ongoing data collection. Determination of the area under the receiver operating characteristic curve (AUROC) was performed to calculate the sensitivity, specificity, and overall correctness of the Eurotransplant-Donor-Risk-Index (ET-DRI) for the prediction of 3-month and 1-year mortality, as well as 3-month and 1-year graft survival. Cut-off values were determined with the best Youden-index. The ET-DRI is unable to predict 3-month mortality (AUROC: 0.477) and 3-month graft survival (AUROC: 0.524) with acceptable sensitivity, specificity and overall correctness (54% and 56.3%, respectively). Logistic regression confirmed this finding (p = 0.573 and p = 0.163, respectively). Determined cut-off values of the ET-DRI for these predictions had no significant influence on long-term patient and graft survival (p = 0.230 and p = 0.083, respectively; Kaplan-Meier analysis with Log-Rank test). The ET-DRI should not be used for donor organ allocation policies without further evaluation, e.g. in combination with relevant recipient variables. Robust and objective prognostic scores for donor organ allocation purposes are desperately needed to balance equity and utility in donor organ allocation.
    Journal of Negative Results in BioMedicine 12/2013; 12(1):18. DOI:10.1186/1477-5751-12-18 · 1.47 Impact Factor
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    • "2009 Zhejiang University school of medecine Hangzhou, China Doyle et al. [73] 2010 Washington University University, St Louis, US Staining H&E N/A H&E Sudan red H&E H&E H&E H&E H&E N/A H&E Macrosteatosis (%) >25 30-60 30-60 30-60 30-60 20-40 30-60 30-60 # 30-60 30-60 No. grafts 8 25 6 34 36 18 3 6 24 22 PNF rate (%) 75+ 0 0 18 $ 4* 5.6 33 0 0 0 12 months graft survival (%) N/A 60 100 73 77% &* 89.7 33 50 91.7 81.5 "
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    ABSTRACT: Steatotic liver grafts represent the most common type of "extended criteria" organs that have been introduced during the last two decades due to the disparity between liver transplant candidates and the number available organs. A precise definition and reliable and reproducible method for steatosis quantification is currently lacking and the potential influence of the chemical composition of hepatic lipids has not been addressed. In our view, these shortcomings appear to contribute significantly to the inconsistent results of studies reporting on graft steatosis and the outcome of liver transplantation. In this review, various definitions, prevalence and methods of quantification of liver steatosis will be covered. Ischemia/reperfusion injury of the steatotic liver and its consequences on post-transplant outcome will be discussed. Selection criteria for organ allocation and a number of emerging protective strategies are suggested.
    Journal of Hepatology 11/2010; 54(5):1055-62. DOI:10.1016/j.jhep.2010.11.004 · 11.34 Impact Factor
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    ABSTRACT: Primary liver allograft nonfunction immediately after transplantation poses a life-threatening situation for the recipient. Emergency retransplantation may not be immediately possible due to organ unavailability. Total hepatectomy with temporary portacaval shunt has been described as a bridge to retransplantation when the presence of the graft appears to be harming the recipient. Case reports of retransplantation after total hepatectomy with anhepatic times greater than 48 hours routinely describe poor outcomes. We present a case with excellent patient outcome after 95 hours of clinical anhepatic state, including 67 hours of anatomical anhepatic time, because of primary liver allograft nonfunction. This case report documents the longest anhepatic time with subsequent successful transplant to date.
    Liver Transplantation 12/2010; 16(12):1428-33. DOI:10.1002/lt.22166 · 4.24 Impact Factor
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