Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index
- 20 July 2011
- journal article
- Published by Wiley in Journal of Gastroenterology and Hepatology
- Vol. 27 (3), 540-546
- https://doi.org/10.1111/j.1440-1746.2011.06844.x
Abstract
Background and Aim: Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes. Methods: A review of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist. Results: Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P < 0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12.09 [8.75–19.05], P = 0.000) and 1 year (P = 0.000). Conclusions: MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI.Keywords
This publication has 25 references indexed in Scilit:
- The biopsied donor liver: Incorporating macrosteatosis into high-risk donor assessmentLiver Transplantation, 2010
- The role of steatosis of the liver graft in the development of post-transplant biliary complicationsTransplant International, 2010
- Predictive value of frozen-section analysis in the histological assessment of steatosis before liver transplantationLiver Transplantation, 2009
- Donor Risk Index and MELD Interactions in Predicting Long-Term Graft Survival: A Single-Centre ExperienceTransplantation, 2009
- The marginal liver donor an updateTransplant International, 2008
- Utility of liver allograft biopsy obtained at procurementLiver Transplantation, 2008
- Use of Extended Criteria Livers Decreases Wait Time for Liver Transplantation Without Adversely Impacting Posttransplant SurvivalAnnals of Surgery, 2006
- Assignment of steatotic livers by the Mayo model for end-stage liver diseaseTransplant International, 2005
- Development of an unbiased method for the estimation of liver steatosisClinical Transplantation, 2004
- A simple scoring system to evaluate the effects of cold ischemia on marginal liver donors1Transplantation, 2004