Author/Authors :
Ferri, Flaminia Department of Translational and Precision Medicine - Sapienza University of Rome, Italy , Lai, Quirino Hepato-Bilio-Pancreatic and Liver Transplant Unit Department of Surgery - Sapienza University of Rome, italy , Molinaro, Antonio Department of Molecular and Clinical Medicine - University of Gothenburg - Sahlgrenska University Hospital, othenburg, Sweden , Poli, Edoardo Centre Hepato-Biliaire - Hopital Paul Brousse, Villejuif, France , Parlati, Lucia Hepatology Department - Universite Paris Descartes - Cochin Hospital, Paris, France , Lattanzi, Barbara Department of Translational and Precision Medicine - Sapienza University of Rome, Italy , Mennini, Gianluca Hepato-Bilio-Pancreatic and Liver Transplant Unit Department of Surgery - Sapienza University of Rome, italy , Melandro, Fabio Hepato-Bilio-Pancreatic and Liver Transplant Unit Department of Surgery - Sapienza University of Rome, italy , Pugliese, Francesco Department of Anaesthesiology Critical Care Medicine and Pain Terapy - Sapienza University of Rome, Italy , Maldarelli, Federica Department of Anaesthesiology Critical Care Medicine and Pain Terapy - Sapienza University of Rome, Italy , Corsi, Alessandro Department of Molecular Medicine - Sapienza University of Rome, Italy , Riminucci, Mara Department of Molecular Medicine - Sapienza University of Rome, Italy , Merli, Manuela Department of Translational and Precision Medicine - Sapienza University of Rome, Italy , Rossi, Massimo Hepato-Bilio-Pancreatic and Liver Transplant Unit Department of Surgery - Sapienza University of Rome, italy , Ginanni Corradini, Stefano Department of Translational and Precision Medicine - Sapienza University of Rome, Italy
Abstract :
Background
No data are available on liver transplantation (LT) outcome and donor liver steatosis, classified as large droplet macrovesicular (Ld-MaS), small-droplet macrovesicular (Sd-MaS), and true microvesicular (MiS), taking into account the recipient Hepatitis C virus (HCV) status.
Aim
We investigate the impact of allograft steatosis reclassified according to the Brunt classification on early graft function and survival after LT.
Methods
We retrospectively reviewed 204 consecutive preischemia biopsies of grafts transplanted in our center during the period 2001-2011 according to recipient HCV status.
Results
The median follow-up after LT was 7.5 years (range: 0.0-16.7). In negative recipients (n=122), graft loss was independently associated with graft Sd-MaS, in multivariable Cox regression models comprehending only pre-/intraoperative variables (HR=1.03, 95%CI=1.01-1.05; P=0.003) and when including indexes of early postoperative graft function (HR=1.04, 95%CI=1.02-1.06; P=0.001). Graft Sd-MaS>15% showed a risk for graft loss > 2.5-folds in both the models. Graft Sd-MaS>15% was associated with reduced graft ATP content and, only in HCV- recipients, with higher early post-LT serum AST peaks.
Conclusions
In HCV-negative recipients, allografts with >15% Sd-MaS have significantly reduced graft survival and show low ATP and higher AST peaks in the immediate posttransplant period. Donors with >15% Sd-MaS have significantly higher BMI, longer ICU stays, and lower PaO2.
