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Resolution of donor non-alcoholic fatty liver disease following liver transplantation
Andrew D Posner1, Samuel T Sultan2, Norann A Zaghloul1
1University of Maryland School of Medicine, Baltimore, MD, USA.
Introduction:
Transplant surgeons conventionally select against livers displaying high degrees (>30%) of macrosteatosis (MaS), out of concern for primary non-function or severe graft dysfunction. As such, there is relatively limited experience with such livers, and the natural history remains incompletely characterized. We present our experience of transplanted livers with high degrees of MaS and microsteatosis (MiS), with a focus on the histopathologic and clinical outcomes.
Methods:
Twenty-nine cases were identified with liver biopsies available from both the donor and the corresponding liver transplant recipient. Donor liver biopsies displayed either MaS or MiS ≥15%, while all recipients received postoperative liver biopsies for cause.
Results:
The mean donor MaS and MiS were 15.6% (range 0%-60%) and 41.3% (7.5%-97.5%), respectively. MaS decreased significantly from donor (M=15.6%) to recipient postoperative biopsies (M=0.86%), P<.001. Similarly, MiS decreased significantly from donor biopsies (M=41.3%) to recipient postoperative biopsies (M=1.8%), P<.001. At a median of 68 days postoperatively (range 4-384), full resolution of MaS and MiS was observed in 27 of 29 recipients.
Conclusions:
High degrees of MaS and MiS in donor livers resolve in recipients following liver transplantation. Further insight into the mechanisms responsible for treating fatty liver diseases could translate into therapeutic targets.
Insights
High degrees of macrosteatosis (MaS) and microsteatosis (MiS) in donor livers resolve after liver transplantation. This finding suggests potential therapeutic targets for treating fatty liver diseases.
Area of Science:
- Hepatology
- Transplant Surgery
- Histopathology
Background:
- Surgeons often avoid donor livers with >30% macrosteatosis (MaS) due to concerns about graft dysfunction.
- Limited data exists on the outcomes of transplanting livers with significant macrosteatosis (MaS) and microsteatosis (MiS).
Purpose of the Study:
- To evaluate the histopathologic and clinical outcomes of liver transplants using donor livers with high degrees of macrosteatosis (MaS) and microsteatosis (MiS).
Main Methods:
- Analyzed 29 liver transplant cases with donor and recipient biopsies.
- Donor biopsies showed macrosteatosis (MaS) or microsteatosis (MiS) ≥15%.
- Recipient postoperative biopsies were obtained for cause.
Main Results:
- Mean donor macrosteatosis (MaS) was 15.6% and microsteatosis (MiS) was 41.3%.
- Significant reductions in both MaS and MiS were observed in recipient postoperative biopsies compared to donor biopsies (P<.001).
- Full resolution of MaS and MiS occurred in 27 of 29 recipients within a median of 68 days.
Conclusions:
- High levels of macrosteatosis (MaS) and microsteatosis (MiS) in donor livers resolve post-transplantation.
- Understanding the resolution mechanisms could lead to new therapeutic strategies for fatty liver disease.
