Grade of donor liver microvesicular steatosis does not affect the postoperative outcome after liver transplantation

Andert, Anne; Ulmer, Tom Florian; Schöning, Wenzel; Kroy, Daniela C.; Hein, Marc; Alizai, Patrick H.; Heidenhain, Christoph; Neumann, Ulf; Schmeding, Maximilian

doi:10.1016/s1499-3872(17)60064-x

Cited by 40 publications

(48 citation statements)

References 28 publications

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“…Four previous studies reported the rates of delayed graft function (DGF)/EAD in patients receiving a liver graft with microsteatosis compared with liver grafts with little or no steatosis. One of those studies showed a higher rate of EAD/DGF, whereas the other 3 studies showed no difference . A lower proportion of patients in the microsteatosis group were admitted directly to the floor, bypassing the ICU (FAST track), than in the no steatosis group.…”

Section: Discussionsupporting

confidence: 90%

“…In the present study, despite the higher rates of PRS and EAD in the microsteatosis group, no difference in graft or patient survival was seen compared with the no steatosis group. These results are consistent with 3 previous studies investigating the outcomes with liver grafts with microsteatosis that also demonstrated no difference in graft survival compared with patients receiving donor livers with no steatosis . These data suggest that the negative impact of using a donor liver with microsteatosis is primarily within the perioperative period and is related to the effects of PRS.…”

Section: Discussioncontrasting

confidence: 43%

“…Previous studies demonstrated that microsteatosis is not associated with an increased risk of PNF or graft failure. (6,7,(9)(10)(11)(12) Although these outcomes are of high importance, many other relevant outcomes exist when assessing outcomes with LT. In the present study, we challenge the notion that microsteatosis does not matter.…”

Section: Discussionmentioning

confidence: 99%

“…The inferior results from using donor livers with significant macrosteatosis have resulted in a reluctance by many centers to use these livers . Alternatively, microsteatosis, even when present to a marked degree, has similar rates of PNF and graft survival to donor livers with no steatosis, except perhaps in the setting of retransplantation …”

mentioning

confidence: 99%

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Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

et al. 2019

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It has been suggested that microsteatosis does not negatively impact graft survival following liver transplantation (LT). The present study represents the largest series on donor livers with significant microsteatosis and investigates the impact of microsteatosis on perioperative factors such as postreperfusion syndrome (PRS), early allograft dysfunction (EAD), and postoperative renal dysfunction. Clinical outcomes of all patients undergoing LT with donor livers with isolated microsteatosis (≥30%; n = 239) between 2000 and 2017 were compared with a propensity score–matched cohort of patients undergoing LT with donor livers with no steatosis (n = 239). Patients in the microsteatosis group had a higher rate of PRS (33.1% versus 24.2%; P = 0.03), EAD (38.2% versus 23.0%; P < 0.001), and continuous renal replacement therapy (CRRT) requirement following LT (10.9% versus 3.6%; P = 0.002) than the no steatosis group. No difference in patient (P = 0.33) or graft survival (P = 0.18) was observed between the 2 groups. On multivariate regression, livers with microsteatosis had an increased risk of graft loss with retransplant recipients (hazard ratio [HR], 1.59; P < 0.001), increasing Model for End‐Stage Liver Disease (MELD) score (HR, 1.13; P = 0.01), and organs from donation after circulatory death donors (HR, 1.46; P = 0.003). In conclusion, recipients of donor livers with significant microsteatosis are at an increased risk of PRS, EAD, and postoperative renal dysfunction requiring CRRT. Livers with significant microsteatosis should be avoided in retransplant recipients and in recipients with high biological MELD scores. Once appropriately selected recipients of these livers are able to overcome the initial perioperative implications of using these donor livers, longterm patient and graft survival is similar to recipients receiving grafts with no steatosis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

et al. 2019

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“…In contrast, microvesicular steatosis is considered a more serious condition often associated with impaired mitochondrial beta‐oxidation and therefore a less favorable prognosis . While some authors have suggested that livers with severe microsteatosis should not be utilized for LT , other including a recent study did not show any negative impact of microsteatosis on post‐LT outcomes.…”

Section: Nash Following Liver Transplantationmentioning

confidence: 99%

Fat and liver transplantation: clinical implications

2018

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Nonalcoholic steatohepatitis (NASH), with or without hepatocellular carcinoma, is a growing indication for liver transplantation (LT) worldwide, particularly in the Western world. Patients with NASH typically combine features of metabolic syndrome with cardiovascular comorbidities, which challenge pre-LT evaluation, surgical approaches, post-LT management, and outcomes. Post-LT survival in NASH patients is excellent, similar to that achieved with other indications, particularly in the absence of cardiovascular comorbidities. Although disease recurrence on the liver allograft is common, progression to advanced disease is uncommon, at least in the short term. Whether this holds true with longer follow-up remains to be determined. Owing to the increased prevalence of nonalcoholic fatty liver disease worldwide, along with a shortened organ pool donation in many countries, utilization of donor grafts with hepatic steatosis is now more common. Understanding the limitations of these grafts as well as potential mechanisms to improve graft quality and/or transplant outcome is clue for transplant centers. In this review, we will summarize current data on evaluation of NASH patients and whether it differs from that applied to other candidates, the natural history of NASH both pre- and post-transplantation, emphasizing on waiting list management and recurrence of the original disease in the new graft as well as post-transplant outcome. Finally, we will discuss the current use of steatotic liver donors and strategies to improve outcome when using this type of grafts.

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The “Skinny” on Assessment and Utilization of Steatotic Liver Grafts: A Systematic Review

Croome¹,

Lee²,

Taner³

2019

Liver Transpl

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The frequency at which steatotic deceased donor liver grafts are encountered will likely continue to increase. Utilization of liver grafts with moderate-to-severe steatosis for liver transplantation (LT) has been previously shown to be associated with increased rates of primary nonfunction and decreased recipient survival. In order to better inform clinical decision making and guide future research, critical evaluation of the literature on donor liver steatosis and posttransplantation outcome is needed. This literature review aims to provide the "skinny" on using deceased donor steatotic livers for LT. Liver Transplantation 25 488-499 2019 AASLD.The obesity epidemic has led to a rise in the number of donor steatotic livers. It has been estimated that 25% of the discarded donor livers are turned down because of excess steatosis. (1) As we continue to look for ways to help address the rising discrepancy between the number of liver transplantation (LT) candidates and the availability of organs, determining which steatotic livers can be safely used is paramount. Utilization of liver grafts with moderate-to-severe steatosis has been previously shown to be associated with increased rates of primary nonfunction (PNF) and decreased recipient survival. (2)(3)(4) However, drawing meaningful conclusions from the literature on donor liver steatosis can be challenging because of the lack of standardized steatosis grading as well as the failure to differentiate macrovesicular and microvesicular steatosis. Indeed, a recent systematic review included many studies that did not differentiate grading based on macrosteatosis and microsteatosis. (5) In order to better inform clinical decision making for transplant professionals and to guide future research, a critical evaluation of the literature on donor steatosis and posttransplantation outcome is needed. The present review aims to provide information on using deceased donor steatotic livers.

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Grade of donor liver microvesicular steatosis does not affect the postoperative outcome after liver transplantation

Cited by 40 publications

References 28 publications

Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity‐Matched Cohort

Fat and liver transplantation: clinical implications

The “Skinny” on Assessment and Utilization of Steatotic Liver Grafts: A Systematic Review

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