The Impact of Steatosis on the Outcome of Liver Transplantation: A Meta-Analysis

Abstract

Background and Aims. Liver transplantation is one of the most effective treatments for end-stage liver disease as well as for cases of acute liver failure. Facing organ donor shortage, liver transplant teams had to use marginal organs. Thus, increasing availability is a key concern of donor liver grafts including steatotic livers. However, the use of steatotic liver is still controversial. The aim of this systematic review and meta-analysis was to analyze the impact of steatosis on the outcome of liver transplantation. Methods. We searched PubMed, Cochrane Library, Embase, Web of knowledge, and so on for studies published through May 31, 2018, in which patients experienced liver transplantation using fatty liver. All studies extracted outcome indicators, and we draw conclusions by contrasting outcome indicators in different groups of steatosis. Odds ratios and 95% confidence intervals were calculated. P<0.05 was considered as statistically significant difference. Results. 19 publications were included. There was no significant difference between the group of no steatosis and mild group in primary nonfunction rate (P=0.605) or early graft dysfunction rate (P=0.44). The PNF rate was significantly higher in moderate group (P=0.003) and severe group (P <0.001) compared with that in no steatosis group. The same results were seen in early graft dysfunction rate. However, graft survival rate and patient survival rate did not differ between groups. Conclusions. Livers with mild steatosis, even with moderate or severe steatosis, could be suitable donor under strict control of transplant conditions.

Application of ischaemia‐free liver transplantation improves prognosis of patients with steatotic donor livers – a retrospective study

“…Zhang et al . [ 26 ] reported in a meta‐analysis that recipients with moderate and severe steatotic donor livers have higher rates of EAD and PNF. Deroose et al .…”

Necroptosis in Hepatosteatotic Ischaemia-Reperfusion Injury

“…Currently, there is debate whether moderate macrosteatosis livers (30–60%) are acceptable for transplantation. Some studies have demonstrated similar PNF rates and survival compared to non-steatotic livers [ 21 , 28 , 29 , 30 ], while others have shown an increased rate of complications, PNF and death [ 28 , 31 ]. However, the use of livers with moderate macrosteatosis is probably justified given the increasing number of patient deaths on liver transplantation waiting lists.…”

Hepatic connective tissue growth factor expression and regulation differ between non-steatotic and non-alcoholic steatotic livers from brain-dead donor

“…Donor shortage and consequent increases in waiting list mortality for liver transplantation have pushed clinicians to utilize extended-criteria liver graft from the brain-dead donors, which can lead to a suboptimal allograft outcome 1 , 2 . Nonalcoholic fatty liver disease (NAFLD) is a frequent contributor to suboptimal allografts from extended-criteria donors 3 .…”