Marginal grafts: finding the correct treatment for fatty livers

Abstract

The influence of steatosis on the outcome of orthotopic liver transplantation (OLT) was evaluated in 860 liver transplantations carried out in 784 patients from October 1990 to August 2001. Donor variables considered were: age, hepatic enzymes, bilirubin, total and warm ischemia times, macrovesicular and microvesicular steatosis. Recipient variables considered were: age, UNOS status, Child-Pugh score and indication for OLT. Patient and graft survival were the main outcome indicators. Macrovesicular steatosis affecting 15% or more of the hepatocytes was the only variable independently associated with shorter patient and graft survival (P = 0.0012 and 0.0028).A significantly worse prognosis was to be expected if >15% macrovesicular steatosis was associated with a total ischemia time >10 h (P= 0.048), or donor age >65 years (P=O.O16) or with HCV-positive recipients (P = 0.0014). From our study we can conclude that macrovesicular steatosis involving 15% or more of the hepatocytes identifies marginal livers. The risk of graft non-function or patient loss after OLT rises if macrovesicular steatosis H5y0 is associated with long ischemia time, high donor age, or HCV positivity in recipients.

Allocation procedure has no impact on patient and graft outcome after liver transplantation

“…have shown that even a macrovesicular steatosis of 15% results in an approximately 20% shorter graft and patient survival. This effect was aggravated if the CIT was longer than 10 h, the recipient was hepatitis C virus positive, or the donor age was >65 years .…”

Initial Poor Graft Dysfunction and Primary Graft Non-Function After Orthotopic Liver Transplantation

“…In the study by Verran et al, 6% of patients receiving grafts with severe macrovesicular fat required retransplantation within 3 months versus 1.4% of those receiving mildly steatotic grafts (Verran et al, 2003). In another multivariate analysis by Salizzoni et al, cumulative adverse factors on the incidence of PGNF included donor age, recipient HCV viremia, and prolonged CIT by use of grafts with over 15% macrovesicular steatosis (Salizzoni et al, 2003).…”

Diffuse reflectance spectroscopy: toward real-time quantification of steatosis in liver

“…Within the degree of fat accumulation in the hepatocytes, the histological evaluation of steatosis can be qualified in two major patterns: microvesicular and macrovesicular steatosis. Microvesicular steatosis solely has been shown to have no negative impact on outcome . Yet, several studies have shown that moderate and severe macrovesicular steatosis of liver grafts is associated with impaired graft function after transplantation .…”