Related Experiment Videos
Use of livers with microvesicular fat safely expands the donor pool
T M Fishbein1, M I Fiel, S Emre
1Division of Abdominal Organ Transplantation, The Mount Sinai Medical Center, New York, New York 10029, USA.
Background:
The safety of transplanting livers with moderate to severe microvesicular steatosis is unknown. Livers that appear fatty are often abandoned at the donor hospital. We have recently used frozen-section biopsy to distinguish between microvesicular and macrovesicular steatosis. We present here our single-center experience with transplantation of 40 allografts with moderate or severe microvesicular steatosis.
Methods:
We reviewed our data on 426 transplants and identified 40 cases in which the donor liver contained at least 30% microvesicular steatosis. Early graft function, patient and graft survival, and donor risk factors for steatosis were examined, and results in this cohort were compared with results in all other patients who received liver transplants at our center during the same time period. We also analyzed the reliability of donor frozen-section biopsies in quantitating microsteatosis. Persistence of steatosis was assessed on the basis of 1-year follow-up biopsies.
Results:
The incidence of primary nonfunction and poor early graft function was 5% and 10%, respectively. One-year patient and graft survival rates were 80% and 72.5%, respectively. Donor obesity and traumatic death were commonly identified risk factors for microvesicular steatosis. Frozen-section biopsy was reliable for pretransplant decision-making about the use of potential grafts, and the steatosis had disappeared from the graft at 1 year in the majority of cases.
Conclusions:
Livers with even severe microvesicular steatosis can be reliably used for transplantation without the fear of high rates of primary nonfunction. There was a significant incidence of poor early graft function, but this did not affect outcome. Microsteatosis is usually associated with some underlying risk factor in the donor and is reversible, as demonstrated by follow-up biopsies after transplant.
Insights
Transplanting livers with moderate to severe microvesicular steatosis is safe and effective. Fatty liver grafts, identified by frozen-section biopsy, show good patient and graft survival rates post-transplant.
Area of Science:
- Hepatology
- Transplantation immunology
- Surgical pathology
Background:
- The safety of using donor livers with moderate to severe microvesicular steatosis for transplantation remains largely unknown.
- Fatty liver allografts are frequently discarded, potentially limiting organ availability.
- Frozen-section biopsy is a novel method to differentiate microvesicular from macrovesicular steatosis.
Purpose of the Study:
- To evaluate the safety and efficacy of transplanting donor livers with moderate to severe microvesicular steatosis.
- To assess early graft function, patient survival, and graft survival in this cohort.
- To determine the reliability of frozen-section biopsy in evaluating steatosis and its reversibility.
Main Methods:
- A retrospective review of 426 liver transplants, identifying 40 cases with ≥30% microvesicular steatosis.
- Analysis of early graft function, patient/graft survival, and donor risk factors.
- Comparison with non-fatty allografts and assessment of frozen-section biopsy reliability and steatosis persistence via follow-up biopsies.
Main Results:
- Primary nonfunction occurred in 5% and poor early graft function in 10% of cases.
- One-year patient and graft survival rates were 80% and 72.5%, respectively.
- Donor obesity and traumatic death were common risk factors; frozen-section biopsy was reliable, and microsteatosis resolved in most grafts within 1 year.
Conclusions:
- Donor livers with moderate to severe microvesicular steatosis can be safely transplanted.
- Despite initial poor graft function, outcomes are not compromised.
- Microsteatosis is often linked to donor risk factors and is typically reversible post-transplant.