Expanding Postmortem Donor Pool Using Steatotic Liver Grafts: A New Look

Expanding Postmortem Donor Pool Using Steatotic Liver Grafts: A New Look

Author Noujaim, Huda M. Google Scholar
Goyet, Jean de Ville de Google Scholar
Montero, Edna F. S. Autor UNIFESP Google Scholar
Ribeiro, Cristiane M. F. Google Scholar
Capellozzi, Vera L. Google Scholar
Crescentini, Fabio Google Scholar
Casagrande, Matheo Google Scholar
Santos, Regina G. Google Scholar
Curvello, Lillian Google Scholar
Miranda, Marcelo P. de Google Scholar
Genzini, Tercio Google Scholar
Institution HEPATO Hosp Beneficencia Portuguesa São Paulo
Osped Pediat Bambino Gesu Roma
Universidade Federal de São Paulo (UNIFESP)
CIP Hosp Beneficencia Portuguesa São Paulo
Universidade de São Paulo (USP)
Abstract Background. Clinical demand for liver transplant steadily grows while organs offer has reached a plateau years ago. To expand the donor liver pool, various options have been considered including acceptance of suboptimal donors and steatotic grafts, with a risk of poorer outcomes. the latter risk and its relation to the grade of liver graft steatosis have been studied in this prospective clinical study.Methods. One hundred eighteen consecutive liver transplantation (115 patients) performed between May 2002 and March 2008 were prospectively analyzed. According to the grade of steatosis on a 2 hr postreperfusion biopsy, four groups were considered: absence (<5%) (n=34), mild (<30%) (n=40), moderate (30%-60%) (n=23), or severe steatosis (>= 60%) (n=21). Donors and recipients demographic data, and patients and grafts survival rates were compared among the four groups.Results. Eighty-four (71%) grafts presented some degree of steatosis (macrosteatosis: 19.5%, microsteatosis: 47%, mix type: 33.5%). Patient and graft survival were significant lower in the severe steatosis group, as a whole. Grafts with less than 30% predominant macro-, or microsteatosis also had poorer outcomes with lower patient and graft survival rates.Conclusion. Steatotic liver grafts were used on a large scale (71%) in this clinical series. the analysis confirms that using grafts with moderate (>30%) and severe steatosis (>60%) have a negative impact on outcomes. the authors conclude that using these grafts allow a significant increase in organ offer that counterbalances the negative outcome for patients who are not offered a transplant, and this supports the need for further clinical research.
Keywords Hepatic steatosis
Marginal donors
Liver transplant
Donor pool
Outcome
Language English
Date 2009-03-27
Published in Transplantation. Philadelphia: Lippincott Williams & Wilkins, v. 87, n. 6, p. 919-925, 2009.
ISSN 0041-1337 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 919-925
Origin http://dx.doi.org/10.1097/TP.0b013e31819b3f76
Access rights Closed access
Type Article
Web of Science ID WOS:000264509900020
URI http://repositorio.unifesp.br/handle/11600/31389

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