Effect of Donor Hepatic Steatosis on Ischemia Reperfusion Injury in Liver Transplant Recipient

Abstract

Introduction: Ischemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI. Aim: The aim of this study was to determine the effect of type and grade of donor liver steatosis on the occurrence and severity of IRI in LT recipients. Methods: This was an observational study conducted at a single center over a period of 37 months from July 2013 to August 2016. Liver biopsy was performed twice, initially at the time of procurement before graft perfusion for steatosis assessment. Steatosis was classified as microsteatosis (MiS) or macrosteatosis (MaS) with mild, moderate, or severe grade. Second biopsy for IRI assessment was taken before skin closure in death donor LT (DDLT) and at the time of transaminitis in postoperative period (<72 hrs) in living donor LT (LDLT). IRI was graded as per neutrophil infiltrate, apoptosis, and hepatocyte cell dropout. Prevalence of IRI and association steatosis was studied along with other factors. Results: Among 53 subjects, 35 were DDLTs and 18 were LDLTs. All live donor grafts were restricted to <15% MaS and the deceased liver grafts had different type and degree of steatosis. In DDLTs, the association between occurrence of IRI and MaS was not statistically significant (P = 0.201). In DDLTs, the mild steatosis was not significantly associated with IRI. Death donor and ischemic time were significantly associated with IRI. Child's stage and MELD scores, gender, and age were not associated with risk of IRI. Severity of IRI is significantly associated with 3-month mortality (P = 0.001). Conclusion: In patients with mild steatosis, IRI does not correlate with steatosis. However, more patients with moderate and severe steatosis are needed to define the relationship of the two in this group of patients. ( J CLIN EXP HEPATOL 2020;10:236-244) L iver transplant (LT) has evolved as the therapy of choice for patients with end-stage liver disease over the past 3 decades. However, the waiting list for liver transplantation is growing at fast pace, whereas the number of available organs is not growing at a proportional rate particularly in countries such as India. The potential use of steatotic livers for transplant, one of the most common types of organs from marginal donors, has become a major focus of investigations. However, the clinical problem is still unresolved because steatotic livers are more susceptible to ischemia reperfusion injury (IRI) and, when used, have poorer outcome than nonsteatotic livers. IRI is an important cause of liver damage occurring during surgical procedures including hepatic resections and LT. [1][2][3] There are recent reports of allograft outcomes with varying combinations of donor macrosteatosis with or without microsteatosis. But there are very few studies on IRI particularly in regard with donor st...

Postreperfusion Liver Biopsy as Predictor of Early Graft Dysfunction and Survival After Orthotopic Liver Transplantation

“…Jadhav et J o u r n a l P r e -p r o o f al. recently reported, in a small study including 52 patients, that severity of IRI was associated with worse 3-month mortality and that prolonged ischaemia time was related to the development of IRI (20). Most interestingly, in our study, when overall survival was assessed, patients with severe IRI exhibited worse overall survival than those with no IRI and mild and moderate IRI.…”

The Role of IGL-2 Preservation Solution on Rat Livers during SCS and HOPE

“…One of the most promising approaches is the use of marginal grafts from steatotic livers or extended criteria donors (ECD) grafts from old donors (over age 60), cardiac death donors, or donors with early non-alcoholic fatty liver disease (NAFLD), also known as liver steatosis [ 2 , 3 ]. They all show a high vulnerability against ischemia-reperfusion injury (IRI), which describes the accumulation of lesions from the liver procurement in the donor (organ recovery, washout, and cold storage preservation) to liver transplantation in the recipient [ 4 , 5 ]. The graft’s static cold storage (SCS) in a cold (5 °C ± 3 °C) preservation solution is the most used strategy in clinical liver transplantation which is characterized by the deprivation of oxygen [ 6 , 7 ].…”