RT Journal
A1 Doyle M, Vachharajani N, Wellen JR, et al
T1 SHort- and long-term outcomes after steatotic liver transplantation
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD July 1
VO 145
IS 7
SP 653
OP 660
DO 10.1001/archsurg.2010.119
UL http://dx.doi.org/10.1001/archsurg.2010.119
AB Objective 
    To determine if the use of steatotic grafts adversely affects outcomes in liver transplantation.Design 
    A retrospective review of a prospectively maintained database.Setting 
    A single center.Patients 
    Four hundred ninety adults who underwent liver transplantation from January 1, 2002, to December 31, 2008, at a single center. Graft biopsies were available in 310 (63.3%) cases. Grafts were classified based on amount of macrovesicular steatosis: 5% or less (n = 222), more than 5% to less than 35% (n = 66), and 35% or more (n = 22).Main Outcome Measures 
    Recipient demographics, Model for End-Stage Liver Disease (MELD) score, patient/graft survival, complications, transfusion rates, and liver function test results.Results 
    One-, 3-, and 5-year patient and graft survivals, respectively, were similar (90.38%, 84.7%, and 74.4%, respectively, P = .3; and 88.7%, 82.5%, and 73.3%, respectively, P = .15). Median follow-up was 25 months. Recipient age, sex, body mass index, laboratory MELD score, and ischemia times were similar among all groups. Packed red blood cell (3 vs 8 U, P < .001), fresh frozen plasma (2 vs 4 U, P = .007), and cryoprecipitate transfusion rates were significantly increased in grafts with 35% or more steatosis. Intensive care unit (5 vs 11 days, P = .02) and hospital (11 vs 21 days, P < .001) stay was also increased in those with grafts with 35% or more steatosis compared with those with 5% or less steatosis. The grafts with 35% or more steatosis had higher transaminase peaks and longer times for bilirubin to normalize (P < .001).Conclusions 
    Use of carefully selected steatotic grafts was not associated with higher rates of primary nonfunction or poorer outcomes. However, the use of steatotic grafts is associated with increased resource use in the perioperative period.