Volume 11 Issue 6
Jan.  2021
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Article Navigation >  ORGAN TRANSPLANTATION  > 2020  >  11(6): 698-703, 736
Tian Dazhi, Jiang Wentao, Chen Chiyi, et al. Analysis of early prognosis and risk factors of donor liver with moderate-to-severe steatosis in adult liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(6): 698-703, 736. doi: 10.3969/j.issn.1674-7445.2020.06.008
Citation: Tian Dazhi, Jiang Wentao, Chen Chiyi, et al. Analysis of early prognosis and risk factors of donor liver with moderate-to-severe steatosis in adult liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(6): 698-703, 736. doi: 10.3969/j.issn.1674-7445.2020.06.008
shu

Analysis of early prognosis and risk factors of donor liver with moderate-to-severe steatosis in adult liver transplantation

doi: 10.3969/j.issn.1674-7445.2020.06.008

  • The First Central College of Tianjin Medical University, Tianjin 300110, China

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  • Corresponding author: Jiang Wentao, Email:jiangwentao@vip.163.com
  • Received Date: 2020-08-03
    Available Online: 2021-01-19
  • Publish Date: 2021-01-19
    Abstract
  •   Objective  To explore the early prognosis and the risk factors of delayed graft function (DGF) of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis.  Methods  Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed. According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit (ANLTU), all recipients were divided into the S0 group (no steatosis, n=308), S1 group (mild steatosis, n=97), S2 group (moderate steatosis, n=52) and S3 group (severe steatosis, n=18), respectively. The early postoperative death and incidence of postoperative complications were statistically compared among each group. The risk factors from donors, recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models.  Results  The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups (all P < 0.05). The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group (P < 0.05). The early postoperative fatality, the incidence of primary nonfunction (PNF) of the transplant liver, postoperative bleeding, infection, biliary complications and vascular complications did not significantly differ among each group (all P > 0.05). Univariate regression analysis showed that severe steatosis of donor liver, long cold ischemia time, high model for end-stage liver disease (MELD) score and tumors of the recipients before operation were the risk factors of DGF (all P < 0.05). Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver, cold ischemia time > 8 h and MELD score > 30 of the recipients were the independent risk factors for early postoperative DGF.  Conclusions  The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high, whereas it does not affect the early survival rate of the recipients. The selection of donor liver with moderate-to-severe steatosis should be considered in combination with cold ischemia time of the donors and MELD score of the recipients before operation, etc.

     

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    • References(25)
  • [1]
    SPRINZL MF, WEINMANN A, LOHSE N, et al. Metabolic syndrome and its association with fatty liver disease after orthotopic liver transplantation[J]. Transpl Int, 2013, 26(1):67-74. DOI: 10.1111/j.1432-2277.2012.01576.x.
    [2]
    HAŁOŃ A, PATRZAŁEK D, RABCZYŃSKI J. Hepatic steatosis in liver transplant donors: rare phenomenon or common feature of donor population?[J]. Transplant Proc, 2006, 38(1):193-195. DOI: 10.1016/j.transproceed.2005.11.088.
    [3]
    DEROOSE JP, KAZEMIER G, ZONDERVAN P, et al. Hepatic steatosis is not always a contraindication for cadaveric liver transplantation[J]. HPB (Oxford), 2011, 13(6):417-425. DOI: 10.1111/j.1477-2574.2011.00310.x.
    [4]
    MOJTABAEE M, SHAMSAEEFAR A, GHOLAMI S, et al. Impact of a full-time donor management protocol on donors' liver biopsy findings: progress to date[J]. Exp Clin Transplant, 2017, 15(Suppl 1):269-272. DOI: 10.6002/ect.mesot2016.P135.
    [5]
    BROWN GT, KLEINER DE. Histopathology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Metabolism, 2016, 65(8):1080-1086. DOI: 10.1016/j.metabol.2015.11.008.
    [6]
    OLTHOFF KM, KULIK L, SAMSTEIN B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors[J]. Liver Transpl, 2010, 16(8):943-949. DOI: 10.1002/lt.22091.
    [7]
    AL-FREAH MAB, MCPHAIL MJW, DIONIGI E, et al. Improving the diagnostic criteria for primary liver graft nonfunction in adults utilizing standard and transportable laboratory parameters: an outcome-based analysis[J]. Am J Transplant, 2017, 17(5):1255-1266. DOI: 10.1111/ajt.14230.
    [8]
    郑飞波, 蒋文涛, 张骊, 等.脂肪变性供肝对成人肝移植早期预后的影响[J].中华普通外科杂志, 2016, 31(3): 201-203. doi: 10.3760/cma.j.issn.1007-631X.2016.03.007

    DOI: 10.3760/cma.j.issn.1007-631X.2016.03.007.
    [9]
    JIA J, NIE Y, LI J, et al. A systematic review and Meta-analysis of machine perfusion vs. static cold storage of liver allografts on liver transplantation outcomes: the future direction of graft preservation[J]. Front Med (Lausanne), 2020, 7:135. DOI: 10.3389/fmed.2020.00135.
    [10]
    LINARES I, HAMAR M, SELZNER N, et al. Steatosis in liver transplantation: current limitations and future strategies[J]. Transplantation, 2019, 103(1):78-90. DOI: 10.1097/TP.0000000000002466.
    [11]
    STRASBERG SM, HOWARD TK, MOLMENTI EP, et al. Selecting the donor liver: risk factors for poor function after orthotopic liver transplantation[J]. Hepatology, 1994, 20(4 Pt 1):829-838. DOI: 10.1002/hep.1840200410.
    [12]
    SPITZER AL, LAO OB, DICK AA, et al. The biopsied donor liver: incorporating macrosteatosis into high-risk donor assessment[J]. Liver Transpl, 2010, 16(7):874-884. DOI: 10.1002/lt.22085.
    [13]
    BOTEON YL, BOTEON APCS, ATTARD J, et al. Ex situ machine perfusion as a tool to recondition steatotic donor livers: troublesome features of fatty livers and the role of defatting therapies. a systematic review[J]. Am J Transplant, 2018, 18(10):2384-2399. DOI: 10.1111/ajt.14992.
    [14]
    HASHIMOTO K. Liver graft from donation after circulatory death donor: real practice to improve graft viability[J]. Clin Mol Hepatol, 2020, 26(4):401-410. DOI: 10.3350/cmh.2020.0072.
    [15]
    CHADHA RM, CROOME KP, ANISKEVICH S, et al. Intraoperative events in liver transplantation using donation after circulatory death donors[J]. Liver Transpl, 2019, 25(12):1833-1840. DOI: 10.1002/lt.25643.
    [16]
    BOTEON YL, STEPHENSON BTF, NEIL DAH, et al. Lipid metabolism and functional assessment of discarded human livers with steatosis undergoing 24 hours of normothermic machine perfusion[J]. Liver Transpl, 2018, 24(5):708-709. DOI: 10.1002/lt.25029.
    [17]
    BRUNT EM. Surgical assessment of significant steatosis in donor livers: the beginning of the end for frozen-section analysis?[J]. Liver Transpl, 2013, 19(4):360-361. DOI: 10.1002/lt.23609.
    [18]
    KUPIEC-WEGLINSKI JW, BUSUTTIL RW. Ischemia and reperfusion injury in liver transplantation[J]. Transplant Proc, 2005, 37(4):1653-1656. DOI: 10.1016/j.transproceed.2005.03.134.
    [19]
    HAN S, KIM G, LEE SK, et al. Comparison of the tolerance of hepatic ischemia/reperfusion injury in living donors: macrosteatosis versus microsteatosis[J]. Liver Transpl, 2014, 20(7):775-783. DOI: 10.1002/lt.23878.
    [20]
    CHALASTI M, IORDANOU C, KRATIRAS Z, et al. Experimental isolation and preservation of solid organs before transplantation: effects of pretreatment using four different molecules[J]. J Int Med Res, 2020, 48(6):300060520933452. DOI: 10.1177/0300060520933452.
    [21]
    MERGENTAL H, LAING RW, KIRKHAM AJ, et al. Transplantation of discarded livers following viability testing with normothermic machine perfusion[J]. Nat Commun, 2020, 11(1):2939. DOI: 10.1038/s41467-020-16251-3.
    [22]
    WESTERKAMP AC, DE BOER MT, VAN DEN BERG AP, et al. Similar outcome after transplantation of moderate macrovesicular steatotic and nonsteatotic livers when the cold ischemia time is kept very short[J]. Transpl Int, 2015, 28(3):319-329. DOI: 10.1111/tri.12504.
    [23]
    CHOLONGITAS E, MARELLI L, SHUSANG V, et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation[J]. Liver Transpl, 2006, 12(7):1049-1061. DOI: 10.1002/lt.20824.
    [24]
    LUO X, LEANZA J, MASSIE AB, et al. MELD as a metric for survival benefit of liver transplantation[J]. Am J Transplant, 2018, 18(5):1231-1237. DOI: 10.1111/ajt.14660.
    [25]
    HALLDORSON JB, CARITHERS RL JR, BHATTACHARYA R, et al. D-MELD risk capping improves post-transplant and overall mortality under markov microsimulation[J]. World J Transplant, 2014, 4(3):206-215. DOI: 10.5500/wjt.v4.i3.206.
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