Abstract
Background No data are available on liver transplantation (LT) outcome and donor liver steatosis, classified as large droplet macrovesicular (Ld-MaS), small-droplet macrovesicular (Sd-MaS), and true microvesicular (MiS), taking into account the recipient Hepatitis C virus (HCV) status. Aim We investigate the impact of allograft steatosis reclassified according to the Brunt classification on early graft function and survival after LT. Methods We retrospectively reviewed 204 consecutive preischemia biopsies of grafts transplanted in our center during the period 2001-2011 according to recipient HCV status. Results The median follow-up after LT was 7.5 years (range: 0.0-16.7). In negative recipients (n=122), graft loss was independently associated with graft Sd-MaS, in multivariable Cox regression models comprehending only pre-/intraoperative variables (HR=1.03, 95%CI=1.01-1.05; P=0.003) and when including indexes of early postoperative graft function (HR=1.04, 95%CI=1.02-1.06; P=0.001). Graft Sd-MaS>15% showed a risk for graft loss > 2.5-folds in both the models. Graft Sd-MaS>15% was associated with reduced graft ATP content and, only in HCV- recipients, with higher early post-LT serum AST peaks. Conclusions In HCV-negative recipients, allografts with >15% Sd-MaS have significantly reduced graft survival and show low ATP and higher AST peaks in the immediate posttransplant period. Donors with >15% Sd-MaS have significantly higher BMI, longer ICU stays, and lower PaO2.
Highlights
The frequency of steatosis in donors for liver transplantation (LT) is increasing over time, showing similar trends as the general population
Among the 122 Hepatitis C virus (HCV)- patients, alcohol-related cirrhosis was the main cause of liver disease (n=36; 29.5%) followed by HBV (n=26; 21.3%) cryptogenic/NASH (n=19; 15.6%), cholestatic disease (n=8; 6.6%), mixed etiologies (n=17; 13.9%), and other causes (n=16; 13.1%); 46 patients had Hepatocellular carcinoma Initial Poor Graft Function (IPGF) (HCC) which was the only indication to LT in 18 patients
In the present study we have investigated the impact on LT outcomes of donor liver steatosis evaluated using protocol preischemia biopsies and revised according to the Brunt classification
Summary
The frequency of steatosis in donors for liver transplantation (LT) is increasing over time, showing similar trends as the general population. Some reports have associated microvesicular steatosis with initial poor graft function, it has been generally accepted that this condition is not associated with reduced graft survival irrespective of the percentage of hepatocytes involved [3, 5,6,7]. Most of these studies did not perform routine protocol biopsies in all the donors, selecting a subclass of grafts according to their gross appearance or donor characteristics. Donors with >15% Sd-MaS have significantly higher BMI, longer ICU stays, and lower PaO2
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