Impact of steatotic grafts on initial function and prognosis after liver transplantation

Afonso, R.C.; Saad, Wael A.; Parra, O.M; Leitão, Rui; Ferraz-Neto, Ben-Hur

doi:10.1016/j.transproceed.2004.03.099

Cited by 22 publications

(24 citation statements)

References 5 publications

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“…Afonso et al . reported a prevalence of initially poor function of the graft after transplantation of 22%, 5 whereas this prevalence was as low as 9% in a study reported by Canello et al . The lower prevalence in Canello's study can be related to overlap with M1 livers, in which the prevalence of initially poor function was as high as 44% 8 .…”

Section: Discussionmentioning

confidence: 84%

“…The widespread shortage of donor organs has led to a more liberal acceptance of donor livers for transplantation with more centres transplanting severely steatotic livers 5,6,12,14,18,19 . A strong association between macrovesicular steatosis and early allograft dysfunction or even primary non‐function has been described previously 1,4,5,7–9,11,12,15,18,19 …”

Section: Discussionmentioning

confidence: 99%

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Hepatic steatosis is not always a contraindication for cadaveric liver transplantation

Deroose

Kazemier

Zondervan

et al. 2011

HPB

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Hepatic steatosis is not always a contraindication for cadaveric liver transplantation

Deroose

Kazemier

Zondervan

et al. 2011

HPB

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“…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%

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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“…Hepatic steatosis is reported to be associated with poor outcome in patients undergoing liver resection and those receiving steatotic donor livers during orthotopic liver transplantation (OLT) [4,5]. However, some centers have also reported excellent outcomes following OLT of severely steatotic donor livers [6,7]. The most notable issue related to hepatic steatosis and surgery is ischemia-reperfusion injury (IRI).…”

Section: Introductionmentioning

confidence: 99%

Effect of Hepatic Steatosis on Bioenergetic Function During Hepatic Ischemia-reperfusion: A Systematic Review

Chu¹

2013

TOTRANSJ

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Abstract:Background: The impact of hepatic steatosis on bioenergetics following hepatic ischemia-reperfusion injury (IRI) remains controversial and is associated with variable reports on its outcome. Large numbers of studies have been published examining the relationship between hepatic steatosis and cellular bioenergetics following hepatic IRI. This systematic review evaluates these studies.Methods: An electronic search of the Medline and Embase databases (January 1946 to June 2012) was performed to select studies that reported relevant outcomes in animal models or patients with hepatic steatosis subjected to IRI.Results: A total of 489 articles were identified, of which 63 animal studies met the predefined criteria and were included in the study. There was large variation in the type of animal model, duration and type of IRI utilized and histological description of hepatic steatosis. Bioenergetic impairments appear to increase the susceptibility of steatotic livers to IRI. The most common impairment was decreased adenosine triphosphate recovery with increased oxidative stress following IRI. Impaired mitochondrial function play a key role in the susceptibility of steatotic livers to IRI.Conclusions: Animals with >30% hepatic steatosis have been shown to have poor outcome following IRI. Despite limitations of different experimental models and inconsistency in histological description, impaired mitochondrial function and bioenergetics appear to be important mediators in the decreased tolerance of steatotic livers to IRI. Future studies need to be consistent and clinically relevant to further improve our understanding of this issue.

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Impact of steatotic grafts on initial function and prognosis after liver transplantation

Cited by 22 publications

References 5 publications

Hepatic steatosis is not always a contraindication for cadaveric liver transplantation

Hepatic steatosis is not always a contraindication for cadaveric liver transplantation

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

Effect of Hepatic Steatosis on Bioenergetic Function During Hepatic Ischemia-reperfusion: A Systematic Review

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