Effect of macrovescicular steatosis and other donor and recipient characteristics on the outcome of liver transplantation

The influence of steatosis and of other donor and recipient characteristics in affecting liver performance post-orthotopic liver transplantation (OLT) was evaluated in 311 consecutive liver transplantations made in 278 patien ts. Donor variables considered were age, sex, blood group, cause of death, intensive care unit (ICU) days, need for vasopressors. hepatic enzymes and bilirubin, total and warm ischemia time, and macro- and microvescicular ste atosis. Recipient variables considered were age, sex, blood group, biliary output, and post-OLT peak levels of hepatic enzymes. Patient and graft surv ival were the main outcome indicators. In the multivariate analysis, macrovescicular steatosis involving 25% or mo re of the hepatocytes was the only variable independently associated with s horter patient survival (p < 0.05). Five (62.5%) of the eight livers with m acrovescicular steatosis involving 25% or more of the hepatocytes incurred in a delayed non-function (DNF) and one (12.5%) in a primary non-function ( PRNF). The incidence of DNF and PRNF in the group with macrovescicular stea tosis involving less than 25% of the liver cells was 1.6% (p < 0.001) and 2 .3%, respectively. Microvescicular steatosis of any degree was not associat ed with a worse prognosis. Macrovescicular steatosis involving 25% or more of the hepatocytes identifies marginal livers, the use of which significant ly increases the risk of graft non-function post-OLT.