title: Influence of donor post-reperfusion changes on graft evolution after liver transplant.
abstract: BACKGROUND
  The increase in indications for liver transplantation has meant that waiting lists are growing ever longer. For this reason, broadening the donor pool is a priority for most groups.
  
  
  OBJECTIVE
  The objective of this study was to analyze the predictive value of post-reperfusion biopsy in the evolution of graft function after liver transplantation.
  
  
  METHODS
  One hundred and forty-eight liver biopsies, obtained after graft reperfusion, were analyzed. Eight pathological variables and thirty-seven clinical variables of the donors were recorded. Risk factors for presenting primary graft non-function or dysfunction were studied with logistic regression models. Factors associated to the long-term graft failure were studied using Cox analysis and actuarial survival curves.
  
  
  RESULTS
  Microvesicular steatosis greater than 50% was the only risk factor associated to graft dysfunction in the multivariate logistic regression model. Microvesicular steatosis greater than 30%, severe hepatocyte necrosis and presence of abundant neutrophilic leukocytes were risk factors associated to graft failure in the univariate study. Only steatosis remained as an independent risk factor in the multivariate study. These grafts also presented poorer long-term survival. Abundant polymorphonuclear infiltrate was associated to a higher frequency of biliary complications.
  
  
  CONCLUSIONS
  Microvesicular steatosis implies a better evolution than macrovesicular steatosis. Neutrophilic infiltrate and hepatocellular necrosis lead to poorer initial graft function and reduced long-term survival.
authors.affiliation: Department of Surgery, Hospital Prínceps d'Espanya, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Busquets
authors.forename: T
authors.initials: T
authors.lastname: Serrano
authors.forename: J
authors.initials: J
authors.lastname: Figueras
authors.forename: E
authors.initials: E
authors.lastname: Ramos
authors.forename: J
authors.initials: J
authors.lastname: Torras
authors.forename: A
authors.initials: A
authors.lastname: Rafecas
authors.forename: J
authors.initials: J
authors.lastname: Fabregat
authors.forename: X
authors.initials: X
authors.lastname: Xiol
authors.forename: C
authors.initials: C
authors.lastname: Lama
authors.forename: L
authors.initials: L
authors.lastname: Ibáñez
authors.forename: E
authors.initials: E
authors.lastname: Jaurrieta
mesh_terms: D000206:Actuarial Analysis; D001706:Biopsy; D006085:Graft Survival; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000502:physiology; D011237:Predictive Value of Tests; D015424:Reperfusion; D012307:Risk Factors