Donor Small-Droplet Macrovesicular Steatosis Affects Liver Transplant Outcome in HCV-Negative Recipients

Area of Science:

• Hepatology
• Transplantation immunology
• Graft pathology

Background:

• Limited data exist on liver transplant (LT) outcomes concerning donor liver steatosis, specifically large droplet macrovesicular (Ld-MaS), small-droplet macrovesicular (Sd-MaS), and true microvesicular (MiS) types.
• Recipient Hepatitis C virus (HCV) status is a critical factor often not fully integrated into steatosis-outcome analyses.

Purpose of the Study:

• To investigate the impact of donor liver steatosis, reclassified using the Brunt classification, on early graft function and long-term survival following liver transplantation.
• To analyze these effects specifically in relation to recipient HCV status.

Main Methods:

• Retrospective review of 204 consecutive pre-ischemia liver graft biopsies.
• Classification of steatosis according to the Brunt criteria.
• Analysis of graft survival and early function in relation to steatosis grade and recipient HCV status, utilizing multivariable Cox regression models.

Main Results:

• In Hepatitis C virus-negative recipients (n=122), graft loss was independently associated with small-droplet macrovesicular steatosis (Sd-MaS).
• Grafts with >15% Sd-MaS demonstrated a >2.5-fold increased risk for graft loss.
• This level of steatosis was linked to reduced graft adenosine triphosphate (ATP) content and higher early post-LT aspartate aminotransferase (AST) peaks in HCV-negative recipients.

Conclusions:

• Allografts with >15% Sd-MaS in HCV-negative recipients exhibit significantly reduced graft survival.
• These grafts display diminished ATP content and elevated AST levels in the early post-transplant phase.
• Donors with >15% Sd-MaS also showed higher BMI, prolonged ICU stays, and lower partial pressure of oxygen (PaO2).