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1. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, Muiesan, Paolo, Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Schlegel, Andrea, van Reeven, Marjolein, Croome, Kristopher, Parente, Alessandro, Dolcet, Annalisa, Widmer, Jeannette, Meurisse, Nicolas, De Carlis, Riccardo, Hessheimer, Amelia, Jochmans, Ina, Mueller, Matteo, van Leeuwen, Otto B, Nair, Amit, Tomiyama, Koji, Sherif, Ahmed, Elsharif, Mohamed, Kron, Philipp, van der Helm, Danny, Borja-Cacho, Daniel, Bohorquez, Humberto, Germanova, Desislava, Dondossola, Daniele, Olivieri, Tiziana, Camagni, Stefania, Gorgen, Andre, Patrono, Damiano, Cescon, Matteo, Croome, Sarah, Panconesi, Rebecca, Flores Carvalho, Mauricio, Ravaioli, Matteo, Caicedo, Juan Carlos, Loss, George, Lucidi, Valerio, Sapisochin, Gonzalo, Romagnoli, Renato, Jassem, Wayel, Colledan, Michele, De Carlis, Luciano, Rossi, Giorgio, Di Benedetto, Fabrizio, Miller, Charles M, van Hoek, Bart, Attia, Magdy, Lodge, Peter, Hernandez-Alejandro, Roberto, Detry, Olivier, Quintini, Cristiano, Oniscu, Gabriel C, Fondevila, Constantino, Malagó, Massimo, Pirenne, Jacques, IJzermans, Jan Nm, Porte, Robert J, Dutkowski, Philipp, Taner, C Burcin, Heaton, Nigel, Clavien, Pierre-Alain, Polak, Wojciech G, and Muiesan, Paolo

Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values. Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered. Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk grou

Published
2022

2. Review Body's Report

Author

Harvey-Smith, E. A., Bliss, Philip, Horner, J. L., Langley, Charles E., Baxter, Iain W., Bewick, James A., Kutar, N., Ahmed, S. A., Breakey, F. W. B., Dumughn, D. B., Hassall, H. M., London, J. M., Deller, J. G., Howard, S. H. F., Ashworth, G. O., and Croome, S. Wilson

Published
1966

5. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

Author

Bart van Hoek, Riccardo De Carlis, Philipp Dutkowski, Gonzalo Sapisochin, Luciano De Carlis, Danny van der Helm, Juan Carlos Caicedo, Erin Winter, Wojciech G. Polak, Humberto Bohorquez, Gabriel C. Oniscu, Fabrizio Di Benedetto, Amna Daud, Paolo Muiesan, V. Lucidi, Daniel Borja-Cacho, C. Burcin Taner, Nicolas Meurisse, Jacques Pirenne, Jeannette Widmer, Amelia J. Hessheimer, Matteo Ravaioli, Wayel Jassem, Mauricio Flores Carvalho, Aad P. van der Berg, Ahmed Sherif, Michele Colledan, Amit Nair, Renato Romagnoli, Diethard Monbaliu, Desislava Germanova, Cristiano Quintini, Andre Gorgen, Matteo Cescon, Sofie Vets, Marco P. A. W. Claasen, Massimo Malagó, Peter Lodge, Stefania Camagni, Kristopher P. Croome, Giorgio Rossi, Robert J. Porte, Ian P.J. Alwayn, Rebecca Panconesi, Maite Paolucci, Philipp Kron, Andrea Schlegel, Vincent E de Meijer, Annalisa Dolcet, Ina Jochmans, Charles Miller, Margherita Carbonaro, Pierre-Alain Clavien, Jan Nm Ijzermans, Constantino Fondevila, Damiano Patrono, Daniele Dondossola, Olivier Detry, Mohamed Elsharif, Koji Tomiyama, Alessandro Parente, Nigel Heaton, Herold J. Metselaar, Matteo Mueller, Tiziana Olivieri, George E. Loss, Marjolein van Reeven, Sarah Croome, Magdy Attia, Roberto Hernandez-Alejandro, Otto B. van Leeuwen, Groningen Institute for Organ Transplantation (GIOT), Center for Liver, Digestive and Metabolic Diseases (CLDM), Schlegel, A, van Reeven, M, Croome, K, Parente, A, Dolcet, A, Widmer, J, Meurisse, N, De Carlis, R, Hessheimer, A, Jochmans, I, Mueller, M, van Leeuwen, O, Nair, A, Tomiyama, K, Sherif, A, Elsharif, M, Kron, P, van der Helm, D, Borja-Cacho, D, Bohorquez, H, Germanova, D, Dondossola, D, Olivieri, T, Camagni, S, Gorgen, A, Patrono, D, Cescon, M, Croome, S, Panconesi, R, Flores Carvalho, M, Ravaioli, M, Caicedo, J, Loss, G, Lucidi, V, Sapisochin, G, Romagnoli, R, Jassem, W, Colledan, M, De Carlis, L, Rossi, G, Di Benedetto, F, Miller, C, van Hoek, B, Attia, M, Lodge, P, Hernandez-Alejandro, R, Detry, O, Quintini, C, Oniscu, G, Fondevila, C, Malagó, M, Pirenne, J, Ijzermans, J, Porte, R, Dutkowski, P, Taner, C, Heaton, N, Clavien, P, Polak, W, Muiesan, P, Surgery, Gastroenterology & Hepatology, Schlegel A., van Reeven M., Croome K., Parente A., Dolcet A., Widmer J., Meurisse N., De Carlis R., Hessheimer A., Jochmans I., Mueller M., van Leeuwen O.B., Nair A., Tomiyama K., Sherif A., Elsharif M., Kron P., van der Helm D., Borja-Cacho D., Bohorquez H., Germanova D., Dondossola D., Olivieri T., Camagni S., Gorgen A., Patrono D., Cescon M., Croome S., Panconesi R., Carvalho M.F., Ravaioli M., Caicedo J.C., Loss G., Lucidi V., Sapisochin G., Romagnoli R., Jassem W., Colledan M., De Carlis L., Rossi G., Di Benedetto F., Miller C.M., van Hoek B., Attia M., Lodge P., Hernandez-Alejandro R., Detry O., Quintini C., Oniscu G.C., Fondevila C., Malago M., Pirenne J., IJzermans J.N.M., Porte R.J., Dutkowski P., Taner C.B., Heaton N., Clavien P.-A., Polak W.G., Muiesan P., Alwayn I.P.J., van der Berg A.P., Carbonaro M., Claasen M., Daud A., de Meijer V.E., Metselaar H.J., Monbaliu D., Paolucci M., Vets S., and Winter E.

Subjects
Male, Organ Dysfunction Scores, benchmarking, Donation after circulatory death, liver transplantation, morbidity, organ perfusion, risk analysis, IMPACT, medicine.medical_treatment, Kaplan-Meier Estimate, Liver transplantation, GUIDELINES, ALLOCATION, law.invention, Cohort Studies, Postoperative Complications, PROPOSAL, Interquartile range, law, Outcome Assessment, Health Care, risk analysi, Mortality rate, EXTENDED-CRITERIA DONORS, Shock, Middle Aged, Editorial from the ACHBPT, Intensive care unit, CARDIAC DEATH, Area Under Curve, Cohort, Female, medicine.medical_specialty, Tissue and Organ Procurement, BILIARY COMPLICATIONS, Cold storage, CLASSIFICATION, Internal medicine, SCORE, medicine, Humans, Renal replacement therapy, Aged, Proportional Hazards Models, GRAFT-SURVIVAL, Hepatology, business.industry, ROC Curve, Complication, business
Abstract

BACKGROUND: To identify the best possible outcomes in liver transplantation from donation after circulatory death donors (DCD) and to propose outcome values, which serve as reference for individual liver recipients or patient groups.METHODS: Based on 2219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1012 low-risk, primary, adult liver transplantations with a laboratory MELD of ≤20points, receiving a DCD liver with a total donor warm ischemia time of ≤30minutes and asystolic donor warm ischemia time of ≤15minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the Comprehensive Complication Index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75th-percentile was considered.RESULTS: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centers. The one-year retransplant and mortality rate was 5.23% and 9.01%, respectively. Within the first year of follow-up, 51.1% of recipients developed at least one major complication (≥Clavien-Dindo-Grade-III). Benchmark cut-offs were ≤3days and ≤16days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade-III), ≤16.8% for ischemic cholangiopathy, and ≤38.9CCI points at one-year posttransplant. Comparisons with higher risk groups showed more complications and impaired graft survival, outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk.CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with more than half of recipients developing severe complications during 1-year follow-up. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups, and provide a valid comparator cohort for future clinical trials.LAY SUMMARY: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2219 liver transplantations following controlled DCD donation in 17 centres worldwide. The following benchmark cut-offs for the most relevant outcome parameters were developed: ICU and hospital stay: ≤3 and ≤16 days; primary non function: ≤2.5%; renal replacement therapy: ≤9.6%; ischemic cholangiopathy: ≤16.8% and anastomotic strictures ≤28.4%. One-year graft loss and mortality were defined as ≤14.4% and 9.6%, respectively. Donor and recipient combinations with higher risk had significantly worse outcomes. The use of novel organ perfusion technology achieved similar, good results in this high-risk group with prolonged donor warm ischemia time, when compared to the benchmark cohort.

Published
2021

6. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation.

Author

Schlegel A, van Reeven M, Croome K, Parente A, Dolcet A, Widmer J, Meurisse N, De Carlis R, Hessheimer A, Jochmans I, Mueller M, van Leeuwen OB, Nair A, Tomiyama K, Sherif A, Elsharif M, Kron P, van der Helm D, Borja-Cacho D, Bohorquez H, Germanova D, Dondossola D, Olivieri T, Camagni S, Gorgen A, Patrono D, Cescon M, Croome S, Panconesi R, Carvalho MF, Ravaioli M, Caicedo JC, Loss G, Lucidi V, Sapisochin G, Romagnoli R, Jassem W, Colledan M, De Carlis L, Rossi G, Di Benedetto F, Miller CM, van Hoek B, Attia M, Lodge P, Hernandez-Alejandro R, Detry O, Quintini C, Oniscu GC, Fondevila C, Malagó M, Pirenne J, IJzermans JNM, Porte RJ, Dutkowski P, Taner CB, Heaton N, Clavien PA, Polak WG, and Muiesan P

Subjects
Aged, Area Under Curve, Benchmarking methods, Benchmarking statistics & numerical data, Cohort Studies, Female, Humans, Kaplan-Meier Estimate, Liver Transplantation methods, Liver Transplantation statistics & numerical data, Male, Middle Aged, Organ Dysfunction Scores, Outcome Assessment, Health Care methods, Postoperative Complications epidemiology, Postoperative Complications etiology, Proportional Hazards Models, ROC Curve, Shock epidemiology, Tissue and Organ Procurement methods, Tissue and Organ Procurement statistics & numerical data, Liver Transplantation adverse effects, Outcome Assessment, Health Care statistics & numerical data, Shock etiology
Abstract

Background & Aims: The concept of benchmarking is established in the field of transplant surgery; however, benchmark values for donation after circulatory death (DCD) liver transplantation are not available. Thus, we aimed to identify the best possible outcomes in DCD liver transplantation and to propose outcome reference values., Methods: Based on 2,219 controlled DCD liver transplantations, collected from 17 centres in North America and Europe, we identified 1,012 low-risk, primary, adult liver transplantations with a laboratory MELD score of ≤20 points, receiving a DCD liver with a total donor warm ischemia time of ≤30 minutes and asystolic donor warm ischemia time of ≤15 minutes. Clinically relevant outcomes were selected and complications were reported according to the Clavien-Dindo-Grading and the comprehensive complication index (CCI). Corresponding benchmark cut-offs were based on median values of each centre, where the 75 th -percentile was considered., Results: Benchmark cases represented between 19.7% and 75% of DCD transplantations in participating centres. The 1-year retransplant and mortality rates were 4.5% and 8.4% in the benchmark group, respectively. Within the first year of follow-up, 51.1% of recipients developed at least 1 major complication (≥Clavien-Dindo-Grade III). Benchmark cut-offs were ≤3 days and ≤16 days for ICU and hospital stay, ≤66% for severe recipient complications (≥Grade III), ≤16.8% for ischemic cholangiopathy, and ≤38.9 CCI points 1 year after transplant. Comparisons with higher risk groups showed more complications and impaired graft survival outside the benchmark cut-offs. Organ perfusion techniques reduced the complications to values below benchmark cut-offs, despite higher graft risk., Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high. Benchmark cut-offs targeting morbidity parameters offer a valid tool to assess the protective value of new preservation technologies in higher risk groups and to provide a valid comparator cohort for future clinical trials., Lay Summary: The best possible outcomes after liver transplantation of grafts donated after circulatory death (DCD) were defined using the concept of benchmarking. These were based on 2,219 liver transplantations following controlled DCD donation in 17 centres worldwide. Donor and recipient combinations with higher risk had significantly worse outcomes. However, the use of novel organ perfusion technology helped high-risk patients achieve similar outcomes as the benchmark cohort., Competing Interests: Conflict of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Published
2022
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7. Sequential Protocol Biopsies Post-Liver Transplant From Donors With Moderate Macrosteatosis: What Happens to the Fat?

Author

Croome KP, Livingston D, Croome S, Keaveny AP, Taner CB, and Nakhleh R

Subjects
Biopsy, Florida epidemiology, Graft Survival, Humans, Retrospective Studies, Tissue Donors, Liver Transplantation adverse effects
Abstract

The number of steatotic deceased donor livers encountered has continued to rise as a result of the obesity epidemic. Little is known about the histological characteristics of moderately macrosteatotic livers over time in the recipient following liver transplantation (LT). All recipients undergoing LT at Mayo Clinic Florida with donor livers with moderate macrosteatosis (30%-60%) from 2000-2017 were identified (n = 96). Routine protocol liver biopsies were performed 1-week and 6-months following LT. All liver donor and protocol biopsies were read by an experienced liver pathologist. Of the 96 moderate macrosteatosis LTs, 70 recipients had post-LT protocol liver biopsies available and comprised the study cohort. Median donor allograft macrosteatosis at the time of transplant was 33% (IQR, 30%-40%) compared with 0% (IQR, 0%-2%) at 1-week (P < 0.001) and 0% (IQR, 0%-0%) at 6-months (P < 0.001) following LT. Biopsies at 1-week post-LT displayed pericentral necrosis in 57.1% of recipients and lipopeliosis in 34.3% of recipients. In the 6-month post-LT biopsies, cholestasis was seen in 3 (4.3%) of the recipients, whereas grade 2 fibrosis was seen in 6 recipients (8.6%). Graft survival at 5 years in the present cohort was 74.0%. Moderate macrosteatosis (30%-60%) in the donor allograft demonstrates complete reversal on liver biopsies performed as early as 7 days following LT and remains absent at 6-months following LT. Both pericentral necrosis and lipopeliosis are common features on day 7 biopsies. Despite these encouraging findings, the perioperative risks of using these livers (postreperfusion cardiac arrest and primary nonfunction) should not be understated. Long-term graft survival is acceptable in patients who are able to overcome the immediate perioperative risk of using moderately steatotic donor livers., (Copyright © 2021 by the American Association for the Study of Liver Diseases.)

Published
2021
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8. Comparison of Supraceliac and Infrarenal Aortic Conduits in Liver Transplantation: Is There a Difference in Patency and Postoperative Renal Dysfunction?

Author

Livingston D, Lee DD, Croome S, Burcin Taner C, and Croome KP

Abstract

Aorto-hepatic conduits can provide arterial inflow for liver transplants in cases where the native hepatic artery is unsuitable for use., Methods: Clinical outcomes of all patients undergoing liver transplantation (LT) with an aorto-hepatic conduit between 2000 and 2016 were included. Recipients were divided into 2 groups: those with a supraceliac (SC) aortic conduit (N = 22) and those with an infrarenal (IR) aortic conduit (N = 82)., Results: There was no difference in calculated model for end-stage liver disease score between the 2 groups. The SC group received grafts with a higher mean donor risk index (1.69 versus 1.48; P = 0.02). Early allograft dysfunction was 18.2% in the SC group and 29.3% in the IR group ( P = 0.30). In the SC group, 10.5% of patients required initiation of postoperative continuous renal replacement therapy compared to 12.1% of patients in the IR group ( P = 0.69). No difference in the rate of postoperative acute kidney injury was seen between the 2 groups ( P = 0.54). No significant difference in median creatinine at 1 year was seen between the SC (1.2 mg/dL; IQR 1-1.3) and IR (1.2 mg/dL; IQR 0.9-1.5) groups ( P = 0.85). At a median follow-up of 5.3 years, thrombosis of the aortic conduit occurred in 0% of patients in the SC group and 6.1% of patients in the IR group ( P = 0.24). Graft survival was not significantly different between the 2 groups ( P = 0.47)., Conclusions: No difference in renal dysfunction as demonstrated by need for post-LT continuous renal replacement therapy, acute kidney injury, or creatinine at 1 year post-LT was seen between SC and IR aortic conduits. A slight trend of higher conduit thrombosis rate was seen with IR compared to SC aortic conduits; however, this did not reach statistical significance. Both SC and IR aortic conduits represent reasonable options when the native hepatic artery is unsuitable for use., (Copyright © 2019 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Published
2019
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9. Does Donor Allograft Microsteatosis Matter? Comparison of Outcomes in Liver Transplantation With a Propensity-Matched Cohort.

Author

Croome KP, Lee DD, Croome S, Nakhleh RE, Abader Sedki Senada P, Livingston D, Yataco M, and Taner CB

Subjects
Adult, Aged, Allografts pathology, Case-Control Studies, Donor Selection statistics & numerical data, End Stage Liver Disease diagnosis, End Stage Liver Disease surgery, Fatty Liver complications, Fatty Liver diagnosis, Fatty Liver pathology, Female, Graft Rejection etiology, Graft Survival, Humans, Liver pathology, Liver Function Tests, Liver Transplantation methods, Male, Middle Aged, Patient Selection, Postoperative Complications etiology, Propensity Score, Renal Insufficiency etiology, Risk Factors, Severity of Illness Index, Tissue Donors statistics & numerical data, Treatment Outcome, Fatty Liver epidemiology, Graft Rejection epidemiology, Liver Transplantation adverse effects, Postoperative Complications epidemiology, Renal Insufficiency epidemiology
Abstract

It has been suggested that microsteatosis does not negatively impact graft survival following liver transplantation (LT). The present study represents the largest series on donor livers with significant microsteatosis and investigates the impact of microsteatosis on perioperative factors such as postreperfusion syndrome (PRS), early allograft dysfunction (EAD), and postoperative renal dysfunction. Clinical outcomes of all patients undergoing LT with donor livers with isolated microsteatosis (≥30%; n = 239) between 2000 and 2017 were compared with a propensity score-matched cohort of patients undergoing LT with donor livers with no steatosis (n = 239). Patients in the microsteatosis group had a higher rate of PRS (33.1% versus 24.2%; P = 0.03), EAD (38.2% versus 23.0%; P < 0.001), and continuous renal replacement therapy (CRRT) requirement following LT (10.9% versus 3.6%; P = 0.002) than the no steatosis group. No difference in patient (P = 0.33) or graft survival (P = 0.18) was observed between the 2 groups. On multivariate regression, livers with microsteatosis had an increased risk of graft loss with retransplant recipients (hazard ratio [HR], 1.59; P < 0.001), increasing Model for End-Stage Liver Disease (MELD) score (HR, 1.13; P = 0.01), and organs from donation after circulatory death donors (HR, 1.46; P = 0.003). In conclusion, recipients of donor livers with significant microsteatosis are at an increased risk of PRS, EAD, and postoperative renal dysfunction requiring CRRT. Livers with significant microsteatosis should be avoided in retransplant recipients and in recipients with high biological MELD scores. Once appropriately selected recipients of these livers are able to overcome the initial perioperative implications of using these donor livers, longterm patient and graft survival is similar to recipients receiving grafts with no steatosis., (Copyright © 2019 by the American Association for the Study of Liver Diseases.)

Published
2019
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10. The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis.

Author

Croome KP, Lee DD, Croome S, Chadha R, Livingston D, Abader P, Keaveny AP, and Taner CB

Subjects
Adult, Aged, Biopsy, End Stage Liver Disease complications, Female, Graft Survival, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Perioperative Period, Postoperative Complications etiology, Propensity Score, Reperfusion, Risk Factors, Tissue Donors, Tissue and Organ Procurement, Treatment Outcome, End Stage Liver Disease surgery, Fatty Liver surgery, Liver pathology, Liver Transplantation, Reperfusion Injury physiopathology
Abstract

The impact of postreperfusion syndrome (PRS) during liver transplantation (LT) using donor livers with significant macrosteatosis is largely unknown. Clinical outcomes of all patients undergoing LT with donor livers with moderate macrosteatosis (30%-60%) (N = 96) between 2000 and 2017 were compared to propensity score matched cohorts of patients undergoing LT with donor livers with mild macrosteatosis (10%-29%) (N = 96) and no steatosis (N = 96). Cardiac arrest at the time of reperfusion was seen in eight (8.3%) of the patients in the moderate macrosteatosis group compared to one (1.0%) of the patients in the mild macrosteatosis group (P = .02) and zero (0%) of the patients in the no steatosis group (P = .004). Patients in the moderate macrosteatosis group had a higher rate of PRS (37.5% vs 18.8%; P = .004), early allograft dysfunction (EAD) (76.4% vs 25.8%; P < .001), renal dysfunction requiring continuous renal replacement therapy following transplant (18.8% vs 8.3%; P = .03) and return to the OR within 30 days (24.0% vs 7.3%; P = .002), than the no steatosis group. Both long-term patient (P = .30 and P = .08) and graft survival (P = .15 and P = .12) were not statistically when comparing the moderate macrosteatosis group to the mild macrosteatosis and no steatosis groups. Recipients of LT using livers with moderate macrosteatosis are at a significant increased risk of PRS. If patients are able to overcome the initial increased perioperative risk of using these donor livers, long-term graft survival does not appear to be different than matched recipients receiving grafts with no steatosis., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Published
2019
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