Steatotic livers. Can we use them in OLTX? Outcome data from a prospective baseline liver biopsy study

Gabrielli, Mauricio; Moisan, Fabrizio; Vidal, Marcela; Duarte, Ignacio; Jiménez, Macarena; Izquierdo, Guillermo; Domínguez, Pilar; Méndez, José Manuel Gómez y; Soza, Alejandro; Benítez, Carlos; Pérez, Rosa; Arrese, Marco; Guerra, Juan Francisco; Jarufe, Nicolás; Martínez, Jorge

doi:10.1016/s1665-2681(19)31415-2

Cited by 49 publications

(39 citation statements)

References 27 publications

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“…We suggest that this might be due to a selection bias in the choice of donors for pediatric recipients. Indeed, donors with an elevated BMI are seldom chosen owing to the increased risk of primary non‐function, even more so after splitting . Although hypothetically non‐absorbable sutures may protect against the occurrence of BC, our use of absorbable suture material did not appear to be a significant risk factor for BC.…”

Section: Discussionmentioning

confidence: 86%

Risk factors for early and late biliary complications in pediatric liver transplantation

Lüthold

Kaseje

Jannot

et al. 2014

Pediatric Transplantation

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BC are a common source of morbidity after pediatric LT. Knowledge about risk factors may help to reduce their incidence. Retrospective analysis of BC in 116 pediatric patients (123 LT) (single institution, 05/1990-12/2011, medium follow-up 7.9 yr). One-, five-, and 10-yr survival was 91.1%, no patient died of BC. Prevalence and risk factors for anastomotic and intrahepatic BC were examined. There were 29 BC in 123 LT (23.6%), with three main categories: 10 (8.1%) primary anastomotic strictures, eight (6.5%) anastomotic leaks, and three (2.4%) intrahepatic strictures. Significant risk factors for anastomotic leaks were total operation time (increase 1.26-fold) and early HAT (<30 days post-LT; increase 5.87-fold). Risk factor for primary anastomotic stricture was duct-to-duct choledochal anastomosis (increase 5.96-fold when compared to biliary-enteric anastomosis). Risk factors for intrahepatic strictures were donor age >48 yr (increase 1.09-fold) and MELD score >30 (increase 1.2-fold). To avoid morbidity from anastomotic BC in pediatric LT, the preferred biliary anastomosis appears to be biliary-enteric. Operation time should be kept to a minimum, and HAT must by all means be prevented. Children with a high MELD score or receiving livers from older donors are at increased risk for intrahepatic strictures.

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Section: Discussionmentioning

confidence: 86%

Risk factors for early and late biliary complications in pediatric liver transplantation

Lüthold

Kaseje

Jannot

et al. 2014

Pediatric Transplantation

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“…Loss of regenerative capacity is the most dramatic age‐associated alteration in the liver, which adversely affects protein synthesis and bile excretion . These changes could be responsible for major susceptibility to endothelial cell preservation injury, steatosis, and longer CIT than that present in younger donors …”

Section: Patient and Graft Survival Using Octogenarian Donors In Livementioning

confidence: 99%

Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

Jaime

Berenguer

2017

Liver Transpl

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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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Steatotic livers. Can we use them in OLTX? Outcome data from a prospective baseline liver biopsy study

Cited by 49 publications

References 27 publications

Risk factors for early and late biliary complications in pediatric liver transplantation

Risk factors for early and late biliary complications in pediatric liver transplantation

Pushing the donor limits: Deceased donor liver transplantation using organs from octogenarian donors

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

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