Inferior Long-Term Outcome of Fatty Liver Allografts After Orthotopic Liver Transplantation

BACKGROUND Liver transplantation remains the only curative treatment modality for patients with end-stage liver disease. The worldwide shortage of donor organs has contributed to the use of fatty livers. However, the long-term survival of recipients who underwent transplantation with fatty livers remains unclear. MATERIAL AND METHODS All orthotopic liver transplantations (OLT) conducted from January 1, 2002, to December 31, 2013, at Hannover Medical School were primarily included (N=337). The assessment of hepatic steatosis was based mainly on histopathology of biopsies, but also included ultrasound and computed tomography imaging and macroscopic organ evaluation. The data were retrospectively analyzed using univariable and multivariable regression analyses and Kaplan-Meier statistics. RESULTS Kaplan-Meier statistics demonstrated a significantly reduced long-term survival for orthotopic liver transplantation of fatty liver allografts, mainly due to increased initial cellular damage and early (in-house) mortality. In the multivariate Cox regression analysis, recipient age (P=0.007; hazard ratio [HR], 1.027); occurrence of postoperative complications (P=0.001; HR, 2.187), and allograft steatosis (P=0.041; HR, 1.427) were independently associated with inferior survival. CONCLUSIONS The results identify fatty liver allografts as an independent risk factor associated with reduced short- and long-term survival after orthotopic liver transplantation. These findings highlight the necessity for strategies to improve outcomes and triggers additional research in the field of organ preservation.