Influence of donor post-reperfusion changes on graft evolution after liver transplant.
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.
Busquets
J
J
Department of Surgery, Hospital Prínceps d'Espanya, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Serrano
T
T
Figueras
J
J
Ramos
E
E
Torras
J
J
Rafecas
A
A
Fabregat
J
J
Xiol
X
X
Lama
C
C
Ibáñez
L
L
Jaurrieta
E
E
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