Influence of Graft Steatosis on the Outcome of Liver Transplantation

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Abstract

Introduction

Steatotic liver grafts represent the most common type of extended criteria of liver grafts organ that have been introduced in the last decade due to the disparity between liver transplant candidates and the number of available organs.

Introduction

The aim of this study was to determine the effect of donor graft steatosis on the outcomes of liver transplantation (LT).

Material and Methods

We performed a retrospective study during the period between 2006-2016. Excluding HIV positive recipients, split grafts, simultaneos liver-kidney transplantation, donors eldier than 70 years, we analyzed 172 patients. The sample divided into 3 groups: normal histology (steatosis<10%), mild steatosis (10-30%), and moderate steatosis (30-60%). Factors such as mortality, overall survival, graft surgical complications, graft rejection were analyzed following the degrees of steatosis.

Results

Among the existing pathology reports of the 172 cases we found 94 (54%) with normal pathology (steatosis less than 10%), 74 (43%) with mild steatosis (10-30%) and 4 (3%) patients with moderate steatosis (30-60%).

Results

If we compare the MELD score before transplantation or the transfusional requierements using the McCluskey index, no differences were seen among the three groups. Mean ICU stay were also similar: 6.7 days in the non steatosis group, 7.6 days in mild steatosis and 3,5 in moderate steatosis (p=0.6).

Results

No difference was observed between the three groups for the incidence of complications such as acute graft rejection (p=0,1), ischemic cholangiopathy (p=0,1), hepatic artery thrombosis or chronic rejection (p=0,2).

Results

Regarding the early allograft disfunction (EAD) and primary non function (PNF), no differences were observed: 8 EAD (8,5%) in no steatosis group and 6 (8,1%) in the mild steatosis. No difference was found on the actuarial survival (AS) at 1,3 and 5 years, being for each group: steatosis<10%, the AS was 87%, 82% and respectively 81%. In mild steatosis group the AS was 85%, 83% and respectively 82% (p=0,5). If we take a look to the early mortality, during the hospitalization stay, 3 (3%) died in the non steatosis group and 6 (8%) in the mild steatosis.

Conclusion

Though we need a larger sample size, we did not find differences in terms of overall survival or complications after LT using grafts with middle to moderate steatosis (<60%).

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