Expanding the donor pool: Outcomes of liver transplantation using grafts with ≥50% macrosteatosis

Area of Science:

• Hepatology
• Transplantation Surgery
• Organ Donation

Background:

• Liver grafts with >50% macrosteatosis are typically considered marginal due to poor outcomes.
• Global organ shortages necessitate the utilization of all available donor organs, including marginal ones.

Purpose of the Study:

• To evaluate the safety and efficacy of using deceased donor liver grafts with 50%-90% macrosteatosis.
• To assess outcomes in recipients undergoing transplantation with these high-risk grafts.

Main Methods:

• Five liver transplants were performed using grafts with 50%-90% macrosteatosis.
• Donor criteria included age <55 years and cold ischemia time (CIT) ≤6 hours.
• Recipient selection was based on a laboratory model for end-stage liver disease (MELD) score ≤30.

Main Results:

• All five patients survived beyond one year with functioning grafts.
• Two patients required reoperation due to thrombotic complications: acute hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT).
• Hospital stay varied significantly, ranging from 6 to 26 days.

Conclusions:

• Transplantation with high macrosteatosis liver grafts is feasible in intermediate- to low-laboratory-MELD recipients.
• Potential thrombotic complications, such as HAT and PVT, must be carefully managed.
• Careful patient selection and monitoring are crucial for successful outcomes when using marginal grafts.