Transplanting Steatotic Livers: Which Factors Associated with Dismal Outcome?

Background: Available liver grafts are by far less than the number of patients waiting for transplantation. That is why transplant community accepted using Extended Criteria Donor (ECD) grafts, but the problem remaining is that a precise, reliable and reproducible characteristic of these grafts is not available up to now. Methods: From November 2012 to October 2014, 70 ECD grafts were used out of 906 liver transplantations performed. Donor criteria, graft criteria and recipient criteria were analyzed. Primary non-functioning graft, delayed functioning graft and 3 to 6 months post-transplant graft functions were also analyzed. Results: The overall incidence of primary non-functioning graft was 11.9%; the incidence of delayed functioning graft was 7.5%; retransplantation incidence was 4.5%; early mortality rate was 17.9%. None of the donor criteria studied was found significantly associated with primary non-function or delayed function of the graft. Moderate macrovesicualr steatosis (30%-60%) was not found significantly associated with PNFG or DFG. MELD score in recipients was not significantly associated with PNEG or DFG. Conclusion: Transplanting moderate steatotic livers (30%-60%) are worthwhile and save lives of patients waiting a long time for good livers. Rejection of ECD grafts for transplantation should be based on transplant surgeon examination of the liver. No specific allocation of ECD grafts for high, moderate,or low MELD score recipient could alleviate post-operative course. However, offering these grafts to high MELD score patients is justified. [ABSTRACT FROM AUTHOR]