title: Safe use of highly steatotic livers by utilizing a donor/recipient clinical algorithm.
abstract: The aim of this study was to assess the long-term safety and clinical outcomes associated with the utilization of highly steatotic donor livers utilizing a specific donor/recipient matching algorithm. This was a prospective, observational, single-center, 10-yr follow-up study. Highly steatotic livers were utilized according to a donor/recipient algorithm that guided the surgeon to use highly steatotic donor organs judiciously in low-risk recipients. This study initially compared fat assessment based on frozen-section Ehrlich's hematoxylin and eosin (H&E) to reperfusion biopsy fat assessment and demonstrated that H&E is an insensitive analysis to determine degree of steatosis. Patients were divided into three groups based on donor steatosis (group 1: <30% steatosis, group 2: 30-60% steatosis, group 3: >60% steatosis), and clinical outcomes were assessed. One hundred and sixteen patients were included in the analysis. Patients that received severely steatotic livers (>60% fat) showed increased reperfusion liver injury and delayed return of liver function in the early postoperative period, demonstrated by biochemical markers. However, there were no differences in primary non-function, postoperative complications, length of stay, and patient and graft survival. Using rigorous donor/recipient matching through a detailed algorithm, these data demonstrate that normal liver allograft outcomes are not superior to those in highly steatotic grafts.
authors.affiliation: Division of Transplantation, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.forename: Melissa
authors.initials: M
authors.lastname: Norcross
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Pilch
authors.forename: Heather
authors.initials: H
authors.lastname: Crego
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bratton
authors.forename: Angello
authors.initials: A
authors.lastname: Lin
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
mesh_terms: D000328:Adult; D000465:Algorithms; D005234:Fatty Liver / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D015427:Reperfusion Injury; D012720:Severity of Illness Index; D015996:Survival Rate
keywords: graft survival; liver transplantation; organ allocation; patient survival; steatosis