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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Microvesicular liver graft steatosis as a risk factor of initial poor function in relation to suboptimal donor
B Cieślak1, Z Lewandowski, M Urban
1Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1a St, 02-097 Warsaw, Poland. bartosz.cieslak@wum.edu.pl
Objective:
We sought to examine the role of microvesicular graft steatosis in relation to donor parameters.
Materials And Methods:
We performed 269 consecutive orthotopic liver transplantations (OLT) between 2004 and 2006. Donor parameters of age, body mass index (BMI), intensive care unit (ICU) stay, hypotension, cardiac arrest, pressors, sodium concentration, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), bilirubin, and activated partial thromboplastin time (APTT), as well as the degree of microvesicular graft steatosis were collected into the study. The endpoint of the study was liver graft dysfunction (AST or ALT > 2500 IU/L or prothrombin index < 50% during the first 7 days after OLT).
Results:
The risk of initial poor function (IPF) at day 7 posttransplantation was significantly related to hepatic microvesicular steatosis (odds ratio [OR] = 1.38 per 1 SD = 9.3%; P < .021). Accounting for the influence of the other donor factors produced little change in the numerical values of relative risk: from 1.22 (following exclusion of GGT) to 1.46 (after elimination of the influence of bilirubin concentration). A 50% increased risk of IPF was equivalent to 12% of the extent of steatosis.
Conclusion:
Microvesicular steatosis is a risk factor for early hepatic dysfunction after OLT.
Insights
Microvesicular steatosis in liver grafts increases the risk of early graft dysfunction after liver transplantation (OLT). This finding highlights the importance of assessing graft steatosis in OLT donor selection.
Area of Science:
- Hepatology
- Transplantation Surgery
- Organ Donation
Background:
- Liver graft steatosis, particularly microvesicular steatosis, is a concern in liver transplantation.
- Donor factors significantly influence liver graft outcomes.
Purpose of the Study:
- To investigate the association between microvesicular graft steatosis and donor parameters.
- To determine the impact of microvesicular steatosis on early liver graft function post-orthotopic liver transplantation (OLT).
Main Methods:
- A cohort of 269 orthotopic liver transplantations (OLT) performed between 2004 and 2006 was analyzed.
- Donor parameters including age, BMI, ICU stay, hemodynamic status, and liver function tests were collected.
- Microvesicular graft steatosis was quantified, and early liver graft dysfunction (within 7 days) was defined as AST or ALT > 2500 IU/L or prothrombin index < 50%.
Main Results:
- Microvesicular hepatic steatosis was significantly associated with an increased risk of initial poor function (IPF) at day 7 post-OLT (OR = 1.38 per 1 SD; P < .021).
- This association remained robust even after accounting for other donor parameters, with relative risks ranging from 1.22 to 1.46.
- A 50% increased risk of IPF corresponded to approximately 12% of the extent of steatosis.
Conclusions:
- Microvesicular steatosis in liver grafts is identified as a significant risk factor for early hepatic dysfunction following OLT.
- The findings underscore the importance of evaluating microvesicular steatosis in donor livers to optimize transplant outcomes.
