Donor Hepatic Steatosis and Outcome After Liver Transplantation: a Systematic Review

Chu, Michael J. J.; Dare, Anna J; Phillips, Anthony R. J.; Bartlett, Adam

doi:10.1007/s11605-015-2832-1

Cited by 159 publications

(151 citation statements)

References 56 publications

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“…In liver transplantation, the presence of macro scopic hepatic steatosis can have serious consequences and increase the risk of primary graft nonfunction 8 , the more severe the steatosis then the greater the risk of hepatic dysfunction. A proportion of potential liver donor grafts have to be discarded if they are too fatty, as above a threshold of steatosis there is an increased risk of graft failure upon transplantation 79,80 . The assess ment of steatosis can be made by the surgeon at the time of organ procurement, but has an inbuilt subjective element.…”

Section: Fatty Livermentioning

confidence: 99%

Liver regeneration — mechanisms and models to clinical application

Forbes

Newsome

2016

Nat Rev Gastroenterol Hepatol

310

296

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Although the normal liver has a fantastic regenerative capacity, following acute injury or resection this regener ative ability becomes overwhelmed in two important scenarios: in the setting of severe acute liver injury or when there is severe chronic liver injury with aberrant liver architecture and marked liver fibrosis 1,2 . These scenarios are clinically relevant and often result in serious morbidity and mortality 3 . While there have been decades of excellent and clinically informative research into understanding the signals that control regener ation of the normal liver 4 , the mechanisms at play when the abnor mal liver attempts regeneration are less well described 5 . Understanding how regeneration fails or is impaired in the severely damaged liver is an important goal. Lessons learned from relevant animal models might have impor tance in the clinical setting and aid the develop ment of new therapies to either promote regener ation or prevent complications that arise during the period of liver regeneration.A clinical scenario in which an improved understand ing of regeneration of the compromised liver would be of benefit includes liver transplantation, here the increas ingly common use of partial liver grafts such as split livers and living donor transplants relies upon regener ation of the donor graft to reach the correct liver mass 6 .Failure of regeneration in these settings results in poor or delayed graft function, prolonged intensive care stays, occasionally a requirement for retransplantation or, ulti mately, even death of the recipient 7,8 . By understanding the pathological mechanisms driving these adverse con ditions it is hoped that the period of regeneration can be more predictable and the associated clinical complications ultimately preventable. The ability to predict or improve liver regeneration when the liver is compromised -for example, in the setting of cirrhosis when surgical resection of hepatocellular cancer (HCC) is commonly performed, or following the resection of colorectal hepatic metastasis, when the liver has received prior chemotherapy -would enable clinicians to optimize cancer resection approaches. Furthermore, by understanding the mechanisms under lying normal liver regeneration and aberrant liver regener ation in chronic liver injury it is hoped that we will be able to promote 'healthy regeneration' or remodel ling in chronic liver disease. Such a scenario in which this approach could be applied includes liver cirrhosis. Here, the initial insult (such as viral hepatitis or autoimmune hepatitis) can sometimes be directly treated, but the liver tissue is left severely damaged and still susceptible to the clinical consequences of liver failure, portal hypertension and an increased risk of HCC 9 .Abstract | Liver regeneration has been studied for many decades and the mechanisms underlying regeneration of the normal liver following resection or moderate damage are well described. A large number of factors extrinsic (such as bile acids and circulating growth factors) and intrinsi...

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Section: Fatty Livermentioning

confidence: 99%

Liver regeneration — mechanisms and models to clinical application

Forbes

Newsome

2016

Nat Rev Gastroenterol Hepatol

310

296

View full text Add to dashboard Cite

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“…Another possible use is in the setting of orthotopic liver transplantation for assessment of fatty liver grafts [10]. It has been shown that >30% hepatic steatosis is associated with decreased graft survival [41]. Hence, a reliable tool for intraoperative evaluation of liver steatosis is required.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Reflectance Spectroscopy for Surface Measurement of Liver Pathology

et al. 2016

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Background: Liver parenchymal injuries such as steatosis, steatohepatitis, fibrosis, and sinusoidal obstruction syndrome can lead to increased morbidity and liver failure after liver resection. Diffuse reflectance spectroscopy (DRS) is an optical measuring method that is fast, convenient, and established. DRS has previously been used on the liver with an invasive technique consisting of a needle that is inserted into the parenchyma. We developed a DRS system with a hand-held probe that is applied to the liver surface. In this study, we investigated the impact of the liver capsule on DRS measurements and whether liver surface measurements are representative of the whole liver. We also wanted to confirm that we could discriminate between tumor and liver parenchyma by DRS. Materials and Methods: The instrumentation setup consisted of a light source, a fiber-optic contact probe, and two spectrometers connected to a computer. Patients scheduled for liver resection due to hepatic malignancy were included, and DRS measurements were performed on the excised liver part with and without the liver capsule and alongside a newly cut surface. To estimate the scattering parameters and tissue chromophore volume fractions, including blood, bile, and fat, the measured diffuse reflectance spectra were applied to an analytical model. Results: In total, 960 DRS spectra from the excised liver tissue of 18 patients were analyzed. All factors analyzed regarding tumor versus liver tissue were significantly different. When measuring through the capsule, the blood volume fraction was found to be 8.4 ± 3.5%, the lipid volume fraction was 9.9 ± 4.7%, and the bile volume fraction was 8.2 ± 4.6%. No differences could be found between surface measurements and cross-sectional measurements. In measurements with/without the liver capsule, the differences in volume fraction were 1.63% (0.75-2.77), -0.54% (-2.97 to 0.32), and -0.15% (-1.06 to 1.24) for blood, lipid, and bile, respectively. Conclusion: This study shows that it is possible to manage DRS measurements through the liver capsule and that surface DRS measurements are representative of the whole liver. The results are consistent with data published earlier on the combination of liver chromophores. The results encourage us to proceed with in vivo measurements for further quantification of the liver's composition and assessment of parenchymal damage such as steatosis and fibrosis grade.

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“…Para utilizar un órgano con tranquilidad con un mínimo impacto en el resultado postrasplante, la mayoría de los grupos acepta en un donante la presencia de esteatosis macrovacuolar leve o menor del 30% (16). Mientras que con esteatosis moderada (mayor del 30% pero menor del 60%), su uso es muy discutido, la incidencia de disfunción primaria puede llegar al 15% y la tasa de la función retardada del injerto se aproxima al 35%.…”

Section: Aspectos Histopatológicos Más Frecuentes Que Pueden Observarunclassified

Aspectos histopatológicos de la evaluación del donante en trasplante hepático, una aproximación a la consulta intraoperatoria

Panqueva¹

2016

Rev. Colomb. Gastroenterol.

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El éxito de un trasplante hepático en gran parte radica en la selección del candidato óptimo y del mejor órga- no. En los últimos años se ha trabajado de forma importante hacia la elaboración de criterios de selección y de asignación basados en la evidencia. La evaluación histopatológica de las biopsias hepáticas desempeña un papel importante en el contexto del trasplante hepático, tanto en la evaluación pretrasplante de órganos considerados como marginales y en el diagnóstico y el tratamiento del paciente que ha recibido un trasplante. El uso de la biopsia intraoperatoria para evaluar órganos marginales en la evaluación pretrasplante es debatido por unos grupos y apoyado por otros. Por otra parte, los cambios morfológicos que ocurren en el postrasplante como el rechazo agudo celular y el rechazo crónico están muy bien reconocidos y la biopsia hepática sigue siendo considerada el patrón oro para el diagnóstico de estas condiciones, no así la biopsia del posible donante, sin embargo su precisión ha sido cuestionada debido en gran parte a la gran variabi- lidad y subjetividad, dadas principalmente por las dificultades diagnósticas que plantea esta patología y a la experiencia del patólogo (1). En esta revisión se discutirán los tópicos más importantes y frecuentes, así como algunos que pueden crear problemas de diagnóstico en patología del trasplante, se hará énfasis en las características patológicas y el diagnóstico diferencial. Los temas serán tratados en tres partes, esta primera entrega corresponde a los aspectos relevantes de la biopsia del donante.

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Donor Hepatic Steatosis and Outcome After Liver Transplantation: a Systematic Review

Cited by 159 publications

References 56 publications

Liver regeneration — mechanisms and models to clinical application

Liver regeneration — mechanisms and models to clinical application

Diffuse Reflectance Spectroscopy for Surface Measurement of Liver Pathology

Aspectos histopatológicos de la evaluación del donante en trasplante hepático, una aproximación a la consulta intraoperatoria

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