[O-48] MACROSTEATOSIS AND INFLUENCE OF THE CRITICAL CARE MANAGEMENT BEFORE RECOVERY OF ORGANS IN DECEASED DONORS.

Vincent Peyregne, Muriel Rabilloud, Ahmed Fahmy, Devon John, Thomas Diflo, Glyn Morgan, Lewis Teperman Transplant Surgery, New York University Langone Medical Center, New York, NY, USA; Service de Biostatistiques, Hospices Civils de Lyon, Lyon Cedex 03, France

Goal: Extended criteria donors are increasingly necessary to meet the demand for organs. Macrosteatosis is a major characteristic of such organs. Our aim was to determine if there was any relationship between the fat content and the donor management prior to recovery. Material and methods: from 1/2005 to 2/2008, 48 grafts with mild or moderate macrosteatosis were identified from the post-perfusion biopsy reports and matched with 137 controls (no or minimal steatosis). Variables related to the donor or management in the Intensive Care Unit with potential effect on steatosis were retrospectively recorded from the UNOS donor package. A multivariate Cox regression model was used to identify any independent risk factor with a p<0.05. Findings: Groups' characteristics are summarized.

Characteristics of patient groups

Variables	Macrosteatosis	Control	p value
Gender ratio (female - male)	39.6 - 60.4%	46.7 - 53.3%	0.406*
Ethnicity (W - AA - H - O)1	72.9 - 12.5 - 10.4 - 4.2%	66.4 - 20.5 - 8 - 5.1%	0.642*
Age (years)	46.2±15	44.9±17	0.622†
Body Mass Index	29.3±6.8	26.2±5.7	0.007†
≥2 drinks daily	58.3%	37.2%	0.017*
IV drug usage	29.2%	24.1%	0.564*
Exposure to hepatotoxic drug	50%	46.7%	0.739*
Diabetes	6.2%	16.1%	0.138*
Hyperlipidemia	4.2%	5.8%	1*
Hypothyroidism	2.1%	5.1%	0.682*
Donation after cardiac death	4.2%	5.1%	1*

1 W = white, AA = African-American, H = hispanic, O = other; *Fischer exact test, exact significance (2-sided); †Student t-test

Independent risk factors for macrosteatosis were: Body Mass Index (OR=1.1 for each increment >27, 95%CI [1.03-1.18]; p=0.005), heavy alcohol use (OR=4.4, 95%CI [3.4-24]; p<0.001), and hypernatremia (OR=1.04 for each increment >145mEq/l, 95%CI [1-1.08]; p=0.045). Dopamine use exhibited a protective effect (OR=0.23, 95%CI [0.09-0.59]; p=0.002). Conclusions: Pre-donation management seemed crucial for the graft fatty change. The need for a tight control of natremia should be stressed. The current levothyroxine and vasopressin protocol was not associated with a better quality of the graft. On the other hand, use of dopamine could be supported from the current results.

Date: Thursday, July 9, 2009
Session Info: Extended Criteria Donors/Disease Transmission (4:45 PM-6:15 PM)
Presentation Time: 5:35 PM
Room: Sutton Center, Level 2