Outcomes after Liver Transplantation with Steatotic Grafts: Redefining Acceptable Cutoffs for Steatotic Grafts

JOURNAL TITLE: Euroasian Journal of Hepato-Gastroenterology

Author
1. Lewis W Teperman
2. Sanjaya K Satapathy
3. Yu Jiang
4. Jinendra Satiya
5. Rajiv P Heda
6. Ben L Da
7. Aaron Winnick
8. Nitzan Roth
9. Lawrence F Lau
10. Ahmed Fahmy
11. Ashwani K Singal
12. Thomas D Schiano
13. Elliot Grodstein
14. Paul J Thuluvath
ISSN
2231-5047
DOI
10.5005/jp-journals-10018-1361
Volume
12
Issue
S1
Publishing Year
2022
Pages
10
Author Affiliations
    1. Division of Hepatology, Department of Internal Medicine, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York, United States of America
    1. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
    1. Department of Internal Medicine, Tulane University, New Orleans, Louisiana, United States of America
    1. Shanghai Minimally Invasive Surgery Center, Surgery Department of Shanghai Ruijin Hospital affiliated to Shanghai JiaoTong University Medical School, Shanghai, China
    1. Division of Transplant, Northwell Health System Transplant Center, Northshore University Hospital, Northwell Health, Manhasset, New York, United States of America
    1. Division of Transplant, Northwell Health System Transplant Center, Northshore University Hospital, Northwell Health, Manhasset, New York, United States of America
    1. Division of Transplant, Northwell Health System Transplant Center, Northshore University Hospital, Northwell Health, Manhasset, New York, United States of America
    1. Division of Hepatology, Department of Internal Medicine, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York, United States of America
    1. Division of Transplant, Northwell Health System Transplant Center, Northshore University Hospital, Northwell Health, Manhasset, New York, United States of America
    1. Institute of Digestive Health and Liver Disease, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
    1. Division of Gastroenterology and Hepatology, University of South Dakota, Avera McKenna University Health Center and Transplant Institute, Sioux Falls, South Dakota, United States of America
    1. Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, United States of America
    1. Division of Transplant, Northwell Health System Transplant Center, Northshore University Hospital, Northwell Health, Manhasset, New York, United States of America
    1. Division of Hepatology, Department of Internal Medicine, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York, United States of America
  • Article keywords
    Allografts, Donor selection, Fatty liver, Liver transplantation, Tissue and organ procurement

    Abstract

    Background: Graft macrosteatosis can predispose to a higher risk of graft loss so we sought to redefine acceptable cutoffs for graft steatosis. Methods: Data of 26,103 donors who underwent liver transplantation (LT) between January 2004 and December 2018 from the UNOS-STAR database were utilized. A high-risk steatotic (HRS) graft and a low-risk steatotic (LRS) graft were defined as ≥20% and <20% macrosteatosis, respectively. High-risk steatotic grafts were further classified as grafts with 20–29% (G1S grafts), 30–39% (G2S grafts), and ≥40% steatosis (G3S grafts). Outcomes between groups were compared. Results: LRS grafts had excellent graft (93.3 and 87.7%) and overall survival (95.4 and 90.5%) at 90 days and 1 year. Compared to LRS grafts, G1S, G2S, and G3S grafts had worse graft and overall survival at 90 days and 1-year (p <0.001). There was no difference in graft or overall survival of G1S or G3S grafts compared to G2S grafts until after adjustment in which G3S grafts were found to be associated with an increased risk of graft loss—aHR 1.27 (1.03–1.57), p = 0.02. Discussion: Liver grafts can be categorized into three categories: (1) <20% or “very low risk”, (2) 20–39% or “low-to-moderate risk”, and usually acceptable, and (3) ≥40% steatosis or “moderate-to-high risk”.

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