Expanding postmortem donor pool using steatotic liver grafts: a new look.
BACKGROUND
Clinical demand for liver transplant steadily grows while organs offer has reached a plateau years ago. To expand the donor liver pool, various options have been considered including acceptance of suboptimal donors and steatotic grafts, with a risk of poorer outcomes. The latter risk and its relation to the grade of liver graft steatosis have been studied in this prospective clinical study.


METHODS
One hundred eighteen consecutive liver transplantation (115 patients) performed between May 2002 and March 2008 were prospectively analyzed. According to the grade of steatosis on a 2 hr postreperfusion biopsy, four groups were considered: absence (<5%) (n=34), mild (<30%) (n=40), moderate (30%-60%) (n=23), or severe steatosis (> or = 60%) (n=21). Donors and recipients demographic data, and patients and grafts survival rates were compared among the four groups.


RESULTS
Eighty-four (71%) grafts presented some degree of steatosis (macrosteatosis: 19.5%, microsteatosis: 47%, mix type: 33.5%). Patient and graft survival were significant lower in the "severe steatosis" group, as a whole. Grafts with less than 30% predominant macro-, or microsteatosis also had poorer outcomes with lower patient and graft survival rates.


CONCLUSIONS
Steatotic liver grafts were used on a large scale (71%) in this clinical series. The analysis confirms that using grafts with moderate (>30%) and severe steatosis (>60%) have a negative impact on outcomes. The authors conclude that using these grafts allow a significant increase in organ offer that counterbalances the negative outcome for patients who are not offered a transplant, and this supports the need for further clinical research.
Noujaim
Huda M
HM
HEPATO of Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil. hudanoujaim@hotmail.com
de Ville de Goyet
Jean
J
Montero
Edna F S
EF
Ribeiro
Cristiane M F
CM
Capellozzi
Vera L
VL
Crescentini
Fabio
F
Casagrande
Matheo
M
Santos
Regina G
RG
Curvello
Lillian
L
de Miranda
Marcelo P
MP
Genzini
Tercio
T
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D002102:Cadaver; D002423:Cause of Death; D005234:Fatty Liver / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000706:statistics & numerical data
D012964:Sodium; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase