title: The biopsied donor liver: incorporating macrosteatosis into high-risk donor assessment.
abstract: To expand the donor liver pool, ways are sought to better define the limits of marginally transplantable organs. The Donor Risk Index (DRI) lists 7 donor characteristics, together with cold ischemia time and location of the donor, as risk factors for graft failure. We hypothesized that donor hepatic steatosis is an additional independent risk factor. We analyzed the Scientific Registry of Transplant Recipients for all adult liver transplants performed from October 1, 2003, through February 6, 2008, with grafts from deceased donors to identify donor characteristics and procurement logistics parameters predictive of decreased graft survival. A proportional hazard model of donor variables, including percent steatosis from higher-risk donors, was created with graft survival as the primary outcome. Of 21,777 transplants, 5051 donors had percent macrovesicular steatosis recorded on donor liver biopsy. Compared to the 16,726 donors with no recorded liver biopsy, the donors with biopsied livers had a higher DRI, were older and more obese, and a higher percentage died from anoxia or stroke than from head trauma. The donors whose livers were biopsied became our study group. Factors most strongly associated with graft failure at 1 year after transplantation with livers from this high-risk donor group were donor age, donor liver macrovesicular steatosis, cold ischemia time, and donation after cardiac death status. In conclusion, in a high-risk donor group, macrovesicular steatosis is an independent risk factor for graft survival, along with other factors of the DRI including donor age, donor race, donation after cardiac death status, and cold ischemia time.
authors.affiliation: Kaiser Permanente, Oakland Medical Center, Department of Surgery, Oakland, CA, USA.
authors.forename: Austin L
authors.initials: AL
authors.lastname: Spitzer
authors.forename: Oliver B
authors.initials: OB
authors.lastname: Lao
authors.forename: André A S
authors.initials: AA
authors.lastname: Dick
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Bakthavatsalam
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Halldorson
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Yeh
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Upton
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Reyes
authors.forename: James D
authors.initials: JD
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D050377:Cold Ischemia; D003643:Death; D005234:Fatty Liver / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000639:trends*; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D055815:Young Adult