The biopsied donor liver: Incorporating macrosteatosis into high-risk donor assessment

Abstract

To expand the donor liver pool, ways are sought to better define the limits of marginally transplantable organs. The Donor Risk Index (DRI) lists 7 donor characteristics, together with cold ischemia time and location of the donor, as risk factors for graft failure. We hypothesized that donor hepatic steatosis is an additional independent risk factor. We analyzed the Scientific Registry of Transplant Recipients for all adult liver transplants performed from October 1, 2003, through February 6, 2008, with grafts from deceased donors to identify donor characteristics and procurement logistics parameters predictive of decreased graft survival. A proportional hazard model of donor variables, including percent steatosis from higher-risk donors, was created with graft survival as the primary outcome. Of 21,777 transplants, 5051 donors had percent macrovesicular steatosis recorded on donor liver biopsy. Compared to the 16,726 donors with no recorded liver biopsy, the donors with biopsied livers had a higher DRI, were older and more obese, and a higher percentage died from anoxia or stroke than from head trauma. The donors whose livers were biopsied became our study group. Factors most strongly associated with graft failure at 1 year after transplantation with livers from this high-risk donor group were donor age, donor liver macrovesicular steatosis, cold ischemia time, and donation after cardiac death status. In conclusion, in a high-risk donor group, macrovesicular steatosis is an independent risk factor for graft survival, along with other factors of the DRI including donor age, donor race, donation after cardiac death status, and cold ischemia time. As attempts have been made to expand the donor pool, defining the limitations of marginal organs for liver transplantation has become more refined and more critical. Many investigators have examined the variables associated with patient and graft outcome after liver transplantation. The variables can be categorized into: donor factors, procurement logistics, recipient factors, and operative factors. Having a clear understanding of the donor factors and procurement logistics factors can improve recipient selection, organ allocation, and potentially patient and graft survival.The Donor Risk Index (DRI) developed in 2006 by Feng et al. 29 contains 7 donor and 2 procurement characteristics (including cold ischemia time [CIT]) that predict an increased risk of graft failure. The objective and quantitative nature of the DRI enables frank discussion between transplant staff and potential recipients regarding the risks involved with prospective donor organs. Importantly, the factors required to determine the DRI are known, and the CIT can be estimated at the time of the organ offer, allowing responsible assessment by transplant staff and Abbreviations: DRI, Donor Risk

Diagnostic Accuracy of Controlled Attenuation Parameter Measured by Transient Elastography for the Non-invasive Assessment of Liver Steatosis: a Prospective Study

“…It may progress towards fibrosis, cirrhosis, and hepatocellular carcinoma [3], it reduces the likelihood of sustained virological response in HCV patients [4] and, in patients undergoing liver resection, it independently increases the risk of postoperative complications and death [5]. In the setting of liver transplantation, the presence of macrovesicular steatosis in the graft increases the 1-year risk of graft failure [6]. Finally, steatosis is the primary lesion in non-alcoholic fatty liver disease (NAFLD), the main cause of CLD in western countries [7].…”

Adult living donor liver imaging

“…There is a higher prevalence of nonalcoholic fatty liver disease among men, and patients with obesity, type 2 diabetes, and hyperlipidemia (40). A recent study showed that the presence of more than 30% of macrovesicular steatosis was an independent risk factor for impaired one-year graft survival (41). Therefore detection of significant fatty liver is a critical component of potential living liver donor evaluation.…”

Aspectos histopatológicos de la evaluación del donante en trasplante hepático, una aproximación a la consulta intraoperatoria

“…Se puede utilizar de una manera similar a la de un hígado de un donante >70 años de edad, es decir cuando no exista ningún otro factor de riesgo asociado (10).…”