[1733] Reassessment of Steatosis in Donor Liver Biopsies

Wei Jiang, John Fung, Bijan Eghtesad, John McMichael, Lisa M Yerian. Cleveland Clinic, Cleveland, OH

Background: Steatosis appears to be an important factor in determining liver allograft suitability and predicting graft function. 30% is a commonly cited steatosis content cutoff for graft use. Studies of livers containing >30% fat have shown mixed results, and controversy exists as to the appropriate assessment of steatosis and viability of steatotic grafts.
Design: We reviewed all donor liver (time-zero and frozen) biopsies performed at our institution from 01/2005 to 10/2010 to assess for macrovesicular, microvesicular, small droplet and total (sum of all types) steatosis. Chart review was performed and graft steatosis was correlated with donor and recipient factors. Outcome measures include primary nonfunction (PNF), graft survival and patient survival. JMP software was used for statistical analyses.
Results: 530 biopsied grafts were used for transplantation. Biopsies were classified by percentage of parenchymal volume involved by various types of steatosis into two groups (<30% and >= 30%). No biopsies contained >5% pure microvesicular steatosis. Small droplet (data not shown) and macrovesicular steatosis were not associated with unfavorable outcomes (Table 1). Total steatosis >=30% was associated with increased PNF in our patient population (table 2). Four grafts showed >= 60% steatosis; one had PNF.

Macrovesicular steatosis
 <30% (n=511)>=30% (n=19)p value
Age (yrs)54.2580.07
Donor age (yrs)
PNF14 (2.7)2 (2.5)0.11
Graft survival at 1 mo480 (93.9)16 (84.2)0.12
Graft survival at 1 yr430 (84.1)16 (84.2)1.0
Pt survival at 1 mo491 (96.1)18 (94.7)0.54
Pt survival at 1 yr441 (86.3)16 (84.2)0.8
Mean for age and N (%) for others.

Total steatosis
 <30% (n=478)>=30% (n=52)p value
Age (yrs)
Donor age (yrs)4146.30.015
PNF11 (2.3)5 (9.8)0.014
Graft survival at 1 mo451 (94.4)45 (86.5)0.07
Graft survival at 1 yr405 (84.7)41 (78.9)0.32
Pt survival at 1 mo460 (96.2)49 (94.2)0.45
Pt survival at 1 yr414 (86.6)43 (82.7)0.4
Mean for age and N (%) for others.

Conclusions: There was no increase in PNF or decrease in graft or patient survival seen with grafts containing >=30% small droplet or macrovesicular steatosis. Total steatosis >=30% was associated with a higher rate of PNF, but did not affect patient or longer term graft survivals. Few patients received >60% steatotic grafts. Further studies are needed to identify additional factors that predict outcome in steatotic grafts.
Category: Liver

Monday, March 19, 2012 1:45 PM

Platform Session: Section E, Monday Afternoon


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