USE OF LIVERS WITH MICROVESICULAR FAT SAFELY EXPANDS THE DONOR POOL

Citation
Tm. Fishbein et al., USE OF LIVERS WITH MICROVESICULAR FAT SAFELY EXPANDS THE DONOR POOL, Transplantation, 64(2), 1997, pp. 248-251
Citations number
11
Categorie Soggetti
Immunology,Surgery,Transplantation
Journal title
ISSN journal
00411337
Volume
64
Issue
2
Year of publication
1997
Pages
248 - 251
Database
ISI
SICI code
0041-1337(1997)64:2<248:UOLWMF>2.0.ZU;2-G
Abstract
Background. The safety of transplanting livers with moderate to severe microvesicular steatosis is unknown. Livers that appear fatty are oft en abandoned at the donor hospital. We have recently used frozen-secti on biopsy to distinguish between microvesicular and macrovesicular ste atosis. We present here our single-center experience with transplantat ion of 40 allografts with moderate or severe microvesicular steatosis. Methods. We reviewed our data on 426 transplants and identified 40 ca ses in which the donor liver contained at least 30% microvesicular ste atosis. Early graft function, patient and graft survival, and donor ri sk factors for steatosis were examined, and results in this cohort wer e compared with results in all other patients who received liver trans plants at our center during the same time period. We also analyzed the reliability of donor frozen-section biopsies in quantitating microste atosis. Persistence of steatosis was assessed on the basis of 1-year f ollow-up biopsies. Results. The incidence of primary nonfunction and p oor early graft function was 5% and 10%, respectively. One-year patien t and graft survival rates were 80% and 72.5%, respectively. Donor obe sity and traumatic death were commonly identified risk factors for mic rovesicular steatosis. Frozen-section biopsy was reliable for pretrans plant decision-making about the use of potential grafts, and the steat osis 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 p rimary nonfunction. There was a significant incidence of poor early gr aft function, but this did not affect outcome. Microsteatosis is usual ly associated with some underlying risk factor in the donor and is rev ersible, as demonstrated by follow-up biopsies after transplant.