Excellent outcome following transplantation of a domino donor liver with high-grade macrosteatosis.
Severe macrosteatosis in the donor liver is considered a major predictive factor of primary graft non-function. Such livers are usually discarded despite an ever-growing need for donor livers. We report our recent experience in a patient (#1) who had an excellent outcome following liver transplantation (LT) of a 65-70% macrosteatotic graft and compare his findings with those of two other (#2 and #3) recipients of moderate to severe macrosteatotic grafts. Both patients (#2 and #3) had initial diminished function, with recovery in patient #2 but delayed graft non-function requiring re-LT (day 24) in patient #3. Patient #1 had no intra-operative complications, while patient #2 had mild complications due to prior adhesions and graft capsular laceration. In patient #3, extensive intra-abdominal adhesions resulting in excessive bleeding occurred during recipient hepatectomy. Total ischemic times: 2.48, 6.10, and 8.18 h; total blood product usage: 43, 81, and 223 units; post-LT hospital stay: 9, 21, and 69 days were seen in patients #1, #2 and #3, respectively. In conclusion, post-LT excellent graft function was seen in one recipient of 65-70% macrosteatotic graft. Transplantation of grafts with moderate/severe macrosteatosis may be inadvisable in patients with extensive intra-abdominal adhesions with expectant excessive bleeding and long ischemia times.
Department of Pathology, New England Medical Center, Boston, MA, USA.
Gissou
G
Azabdaftari
Elizabeth A
EA
Pomfret
Mary Ann
MA
Simpson
James J
JJ
Pomposelli
W David
WD
Lewis
Roger L
RL
Jenkins
Fredric D
FD
Gordon
Urmila
U
Khettry
D000005:Abdomen; D000328:Adult; D000075202:Contraindications; D005234:Fatty Liver / Q000473:pathology*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications; D022125:Lacerations / Q000209:etiology; D008099:Liver / Q000293:injuries; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000150:complications; D014019:Tissue Donors; D016896:Treatment Outcome