Steatosis in donor and transplant liver biopsies

The purpose of this study was to identify the significance and clinical cor relation of steatosis in donor and posttransplantation liver biopsies. One hundred twenty-six liver biopsies with fatty change from 86 liver transplan t patients were reviewed, Micro- and macro-steatosis were graded semiquanti tatively and correlated with clinical and other pathologic parameters. Fift y-one donor biopsy specimens, from 50 patients, had combinations of micro- (predominantly) and macro-steatosis. One of 2 patients with high-grade micr o- and macro-steatosis required a retransplantation on the third day. Three early deaths were not related to graft dysfunction. In 36 patients, steato sis developed after transplantation. In 13 of 36, steatosis was seen in the early postoperative period with a background of severe ischemic injury, 6 of whom died within 45 days posttransplantation. Other causes of steatosis developing after liver transplantation included hepatitis C (n = 12), alcoh olic steatohepatitis (n = 3), diabetes mellitus or obesity (n = 7) and poor nutrition (n = 2). The presence of steatosis in 1 patient's donor and all posttransplantation biopsy specimens remained unexplained. In conclusion, ( 1) microsteatosis in donor liver biopsy specimens has no effect on graft fu nction; (2) ischemic injury with development of steatosis in the early post transplantation period may be associated with poor clinical outcome; and (3 ) steatosis in the posttransplantation period is uncommon and usually relat ed to recurrent or acquired hepatitis C. HUM PATHOL 31: 1209-1213. Copyrigh t (C) 2000 by W.B. Saunders Company.