title: Influence of degree of hepatic steatosis on graft function and postoperative complications of liver transplantation.
abstract: The aim of this study was to evaluate the impact on initial graft function of the degree of steatosis detected in the back-table biopsy, and its repercussion on the clinical results of the transplant (early posttransplant mortality and morbidity). We undertook a retrospective analysis of 300 liver transplants performed at our center from 1997 to 2004. A wedge liver biopsy was done routinely during back-table surgery (available in 294 transplants). The degree of steatosis was classified as: S0-no steatosis, 201 transplants; S1-mild steatosis (<30%), 58 transplants; S2-moderate steatosis (30% to 60%), 18 transplants; and S3-severe steatosis (>60%), 17 transplants. The ischemia-reperfusion (I/R) injury, based on the maximum mean peak aspartate transferase in the first 72 posttransplant hours, tended to be greater as the degree of graft steatosis increased: S0, 1316; S1, 1985; S2, 2446; and S3, 2955 (P < .005 between S0 and S3). This greater initial hepatic dysfunction was correlated in the group with severe steatosis with a higher rate of severe renal failure requiring hemofiltration/hemodialysis: S0, 9%; S1, 15%; S2, 11%; and S3, 41% (P < .001); as well as with a higher early mortality (90 days): S0, 10%; S1, 21%; S2, 11%; and S3, 41% (P < .001). The Kaplan-Meier survival curve showed a significant difference (log-rank and Breslow) between the group with severe steatosis and the group with no steatosis (P = .002). We conclude that the degree of liver graft steatosis is an important determinant of I/R injury, although this progressive increase in the I/R injury with the degree of steatosis only had clinical repercussions in the case of severe steatosis.
authors.affiliation: Unit of HBP Surgery and Liver Transplantation, H. R. Carlos Haya, Malaga, Spain. perezdaga@hotmail.com
authors.forename: J A
authors.initials: JA
authors.lastname: Perez-Daga
authors.forename: J
authors.initials: J
authors.lastname: Santoyo
authors.forename: M A
authors.initials: MA
authors.lastname: Suárez
authors.forename: J A
authors.initials: JA
authors.lastname: Fernández-Aguilar
authors.forename: C
authors.initials: C
authors.lastname: Ramírez
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Cañete
authors.forename: J M
authors.initials: JM
authors.lastname: Aranda
authors.forename: B
authors.initials: B
authors.lastname: Sánchez-Pérez
authors.forename: C
authors.initials: C
authors.lastname: Montiel
authors.forename: D
authors.initials: D
authors.lastname: Palomo
authors.forename: M
authors.initials: M
authors.lastname: Ruiz
authors.forename: A
authors.initials: A
authors.lastname: Mate
mesh_terms: D005234:Fatty Liver / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome