title: Grade of deceased donor liver macrovesicular steatosis impacts graft and recipient outcomes more than the Donor Risk Index.
abstract: OBJECTIVE
  Donor liver steatosis can impact on liver allograft outcomes. The aim of the present study was to comprehensively report on the impact of type and grade of donor steatosis, as well as donor and recipient factors, including the reported Donor Risk Index (DRI), on liver allograft outcomes.
  
  
  METHODS
  A review of unit data for all adult liver transplant procedures from 2001 to 2007, as well as donor offers. Donor liver biopsies were regraded for steatosis by an experienced histopathologist.
  
  
  RESULTS
  Steatosis was detected in 184/255 (72%) of biopsies, of which 114 (62%) had microvesicular steatosis (MiS; 68 mild, 22 moderate, 24 severe) and 70 (38%) macrovesicular steatosis (MaS; 59 mild, 7 moderate, 4 severe). The majority (66/70, 94%) of biopsies with MaS also contained MiS. Allograft steatosis was associated with increasing donor body mass index (P = 0.000), plus donor male sex (P < 0.05). Primary non function (P = 0.002), early renal failure (P = 0.040), and requirement for retransplantation (P = 0.012) were associated only with severe MaS. Early biliary complications were associated with moderate MaS (P = 0.039). Only severe MaS was significantly associated with inferior allograft survival at 3 months (relative risk = 12.09 [8.75-19.05], P = 0.000) and 1 year (P = 0.000).
  
  
  CONCLUSIONS
  MiS is a common finding and frequently coexists with MaS on liver allograft biopsy, while isolated MaS is uncommon. Only the presence of moderate to severe MaS is associated with inferior early allograft outcomes. The impact of severe MaS on allograft survival appears greater than other donor factors, including the calculated DRI.
authors.affiliation: Medical School, University of Groningen, Groningen, the Netherlands.
authors.forename: Esther L
authors.initials: EL
authors.lastname: de Graaf
authors.forename: James
authors.initials: J
authors.lastname: Kench
authors.forename: Pamela
authors.initials: P
authors.lastname: Dilworth
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Shackel
authors.forename: Simone I
authors.initials: SI
authors.lastname: Strasser
authors.forename: David
authors.initials: D
authors.lastname: Joseph
authors.forename: Henry
authors.initials: H
authors.lastname: Pleass
authors.forename: Michael
authors.initials: M
authors.lastname: Crawford
authors.forename: Geoff W
authors.initials: GW
authors.lastname: McCaughan
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Verran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D005234:Fatty Liver / Q000145:classification / Q000150:complications* / Q000473:pathology*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000209:etiology*; D012086:Reoperation; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult