Use of steatotic graft in living-donor liver transplantation.
BACKGROUND
The degree of fatty infiltration in hepatic grafts is known to be an important risk factor for primary graft nonfunction in cadaveric liver transplantation. However, the effect of hepatic steatosis in living-donor liver transplantation (LDLT) has not yet been well defined. In this study, we evaluated the impact that the degree of hepatic graft steatosis has on the outcome of LDLT.


METHODS
Sixty consecutive donors and recipients who underwent LDLT between October 1996 and August 2001 at Kyushu University Hospital were the subjects of this study. The pathologic findings of the prereperfusion biopsy of the graft were classified into the following three groups according to the degree of macrovesicular steatosis: None (n=23), 0% steatosis; Mild (n=23), 0% to 20% steatosis; and Moderate (n=6), 20% to 50% steatosis. Liver function tests including total bilirubin (at postoperative day [POD] 7), the peak alanine aminotransferase (ALT) and prothrombin time (at POD 3), and both patient and graft survival were compared among the groups. Furthermore, we also compared the donor parameters including the peak ALT and total bilirubin (at POD 3) and the operative time, blood loss, and length of hospital stay after surgery.


RESULTS
The 1-year patient and graft survival were comparable among the groups. The peak ALT was significantly higher in the Moderate group (606+/-641 IU/L) than in the None (290+/-190 IU/L) and Mild (376+/-296 IU/L) groups. Total bilirubin (POD 7) and prothrombin time (POD 3) were comparable among the groups. The donor parameters were comparable among the groups except for the fact that the donor body weight of the Mild and Moderate groups were significantly heavier (P<0.0001) than that of the None group.


CONCLUSIONS
In conclusion, the use of a fatty liver graft up to the moderate level can be justified in LDLT, even though ischemia-reperfusion injury tends to be severe in such grafts.
Soejima
Yuji
Y
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. ysoejima@surg2.med.kyushu-u.ac.jp.
Shimada
Mitsuo
M
Suehiro
Taketoshi
T
Kishikawa
Keiji
K
Yoshizumi
Tomoharu
T
Hashimoto
Koji
K
Minagawa
Ryosuke
R
Hiroshige
Shoji
S
Terashi
Takahiro
T
Ninomiya
Mizuki
M
Shiotani
Satoko
S
Harada
Noboru
N
Sugimachi
Keizo
K
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D001835:Body Weight; D002648:Child; D005234:Fatty Liver / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D012720:Severity of Illness Index
D000410:Alanine Transaminase; D001663:Bilirubin