PURPOSE OF REVIEW: Due to a persistent shortage of donor livers, attention has turned toward ways of utilizing marginal grafts, particularly those with steatosis, without incurring inferior outcomes. Here we review the evaluation and utilization of steatotic liver allografts, highlight recently published data, and discuss novel methods of graft rehabilitation. RECENT FINDINGS: Although severe liver allograft (>60%) steatosis has been associated with inferior graft and recipient outcomes, mild (<30%) steatosis has not. There is ongoing debate regarding safe utilization of grafts with moderate (30-60%) steatosis. Presently, no established protocols for evaluating steatosis in donor candidates or utilizing such grafts exist. Liver biopsy is accepted as the gold standard technique, though noninvasive methods have shown promise in accurately predicting steatosis. More recently, machine perfusion has been shown to enhance ex situ liver function and reduce steatosis, emerging as a potential means of optimizing steatotic grafts prior to transplantation. SUMMARY: Steatotic liver allografts constitute a large proportion of deceased donor organs. Further work is necessary to define safe upper limits for the acceptable degree of steatosis, develop standardized evaluation protocols, and establish utilization guidelines that prioritize safety. Machine perfusion has shown promise in rehabilitating steatotic grafts and offers the possibility of expanding the deceased donor pool.
PURPOSE OF REVIEW: Due to a persistent shortage of donor livers, attention has turned toward ways of utilizing marginal grafts, particularly those with steatosis, without incurring inferior outcomes. Here we review the evaluation and utilization of steatotic liver allografts, highlight recently published data, and discuss novel methods of graft rehabilitation. RECENT FINDINGS: Although severe liver allograft (>60%) steatosis has been associated with inferior graft and recipient outcomes, mild (<30%) steatosis has not. There is ongoing debate regarding safe utilization of grafts with moderate (30-60%) steatosis. Presently, no established protocols for evaluating steatosis in donor candidates or utilizing such grafts exist. Liver biopsy is accepted as the gold standard technique, though noninvasive methods have shown promise in accurately predicting steatosis. More recently, machine perfusion has been shown to enhance ex situ liver function and reduce steatosis, emerging as a potential means of optimizing steatotic grafts prior to transplantation. SUMMARY: Steatotic liver allografts constitute a large proportion of deceased donor organs. Further work is necessary to define safe upper limits for the acceptable degree of steatosis, develop standardized evaluation protocols, and establish utilization guidelines that prioritize safety. Machine perfusion has shown promise in rehabilitating steatotic grafts and offers the possibility of expanding the deceased donor pool.
Authors: Yuri L Boteon; Amanda P C S Boteon; Joseph Attard; Hynek Mergental; Darius F Mirza; Ricky H Bhogal; Simon C Afford Journal: Am J Transplant Date: 2018-07-24 Impact factor: 8.086
Authors: Kristopher P Croome; David D Lee; Sarah Croome; Ryan Chadha; David Livingston; Peter Abader; Andrew Paul Keaveny; C Burcin Taner Journal: Am J Transplant Date: 2019-03-26 Impact factor: 8.086
Authors: Paolo Caraceni; Marco Domenicali; Gianluigi Vendemiale; Ignazio Grattagliano; Annamaria Pertosa; Bruno Nardo; Antonio Maria Morselli-Labate; Franco Trevisani; Giuseppe Palasciano; Emanuele Altomare; Mauro Bernardi Journal: J Surg Res Date: 2005-04 Impact factor: 2.192
Authors: Marc-Antoine Allard; Carlos Castro-Benitez; Katsunori Imai; Jasmijn Selten; Alexandre Lopez; Mylène Sebagh; Antoinette Lemoine; Antonio Sa Cunha; Daniel Cherqui; Denis Castaing; Eric Vibert; René Adam Journal: Clin Transplant Date: 2018-05-07 Impact factor: 2.863