Elsevier

Transplantation Proceedings

Volume 41, Issue 8, October 2009, Pages 2985-2988
Transplantation Proceedings

Donation
Microvesicular Liver Graft Steatosis as a Risk Factor of Initial Poor Function in Relation to Suboptimal Donor Parameters

https://doi.org/10.1016/j.transproceed.2009.08.019Get rights and content

Abstract

Objective

We sought to examine the role of microvesicular graft steatosis in relation to donor parameters.

Materials and Methods

We performed 269 consecutive orthotopic liver transplantations (OLT) between 2004 and 2006. Donor parameters of age, body mass index (BMI), intensive care unit (ICU) stay, hypotension, cardiac arrest, pressors, sodium concentration, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), bilirubin, and activated partial thromboplastin time (APTT), as well as the degree of microvesicular graft steatosis were collected into the study. The endpoint of the study was liver graft dysfunction (AST or ALT > 2500 IU/L or prothrombin index < 50% during the first 7 days after OLT).

Results

The risk of initial poor function (IPF) at day 7 posttransplantation was significantly related to hepatic microvesicular steatosis (odds ratio [OR] = 1.38 per 1 SD = 9.3%; P < .021). Accounting for the influence of the other donor factors produced little change in the numerical values of relative risk: from 1.22 (following exclusion of GGT) to 1.46 (after elimination of the influence of bilirubin concentration). A 50% increased risk of IPF was equivalent to 12% of the extent of steatosis.

Conclusion

Microvesicular steatosis is a risk factor for early hepatic dysfunction after OLT.

Section snippets

Materials and Methods

Among 269 cases of OLT performed between 2004 and 2006, we excluded retransplantations and multiorgan transplantations. The donor parameters taken into account included: age, body mass index (BMI), intensive care unit (ICU) stay, arterial hypotension, cardiac arrest, sodium concentration, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), bilirubin concentration, activated partial thromboplastin time (APTT), international normalized ratio

Results

The risk of IPF at day 7 posttransplantation was significantly related to hepatic microvesicular steatosis (OR = 1.38 per 1 SD = 9.3%; P < .021). Accounting for the influence of the other donor factors produced little change in the numerical values of relative risk: from 1.22 (following exclusion of GGT) to 1.46 (after elimination of the influence of bilirubin concentration). A 50% increased risk of IPF was equivalent to 12% of the extent of steatosis. As shown in the Fig 1, an increasing risk

Discussion

Hepatic steatosis is frequently encountered in the European population, a prevalence of 20% to 30% of adults.5, 6 The frequency of this condition among the Polish population is regarded to be similar to the European average, although a frequency has been cited of as much as 50% of persons with steatosis.7 Steatosis of considerable degree is regarded as evidence of ischemia/reperfusion injury; consequently, it is a hepatic dysfunction factor equivalent to IPF and primary nonfunction (PNF). It

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