A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

Justin A. Steggerda, MD; Daniel Borja-Cacho, MD; Todd V. Brennan, MD; Tsuyoshi Todo, MD; Nicholas N. Nissen, MD; Matthew B. Bloom, MD; Andrew S. Klein, MD; Irene K. Kim, MD

doi:10.1097/TXD.0000000000001280

Transplantation Direct (Feb 2022)

A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

Justin A. Steggerda, MD,
Daniel Borja-Cacho, MD,
Todd V. Brennan, MD,
Tsuyoshi Todo, MD,
Nicholas N. Nissen, MD,
Matthew B. Bloom, MD,
Andrew S. Klein, MD,
Irene K. Kim, MD

Affiliations

Justin A. Steggerda, MD: 1 Division of Transplantation, Department of Surgery, Northwestern Memorial Hospital, Chicago, IL.
Daniel Borja-Cacho, MD: 1 Division of Transplantation, Department of Surgery, Northwestern Memorial Hospital, Chicago, IL.
Todd V. Brennan, MD: 2 Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Tsuyoshi Todo, MD: 2 Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Nicholas N. Nissen, MD: 2 Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Matthew B. Bloom, MD: 3 Division of Trauma and Critical Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Andrew S. Klein, MD: 2 Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Irene K. Kim, MD: 2 Division of Transplantation, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

DOI: https://doi.org/10.1097/TXD.0000000000001280
Journal volume & issue: Vol. 8, no. 2
p. e1280

Abstract

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Background. Donor liver biopsy (DLBx) in liver transplantation provides information on allograft quality; however, predicting outcomes from these allografts remains difficult. Methods. Between 2006 and 2015, 16 691 transplants with DLBx were identified from the Standard Transplant Analysis and Research database. Cox proportional hazard regression analyses identified donor and recipient characteristics associated with 30-d, 90-d, 1-y, and 3-y graft survival. A composite model, the Liver Transplant After Biopsy (LTAB) score, was created. The Mini-LTAB was then derived consisting of only donor age, macrosteatosis on DLBx, recipient model for end-stage liver disease score, and cold ischemic time. Risk groups were identified for each score and graft survival was evaluated. P values <0.05 were considered significant. Results. The LTAB model used 14 variables and 5 risk groups and identified low-, mild-, moderate-, high-, and severe-risk groups. Compared with moderate-risk recipients, severe-risk recipients had increased risk of graft loss at 30 d (hazard ratio, 3.270; 95% confidence interval, 2.568-4.120) and at 1 y (2.258; 1.928-2.544). The Mini-LTAB model identified low-, moderate-, and high-risk groups. Graft survival in Mini-LTAB high-risk transplants was significantly lower than moderate- or low-risk transplants at all time points. Conclusions. The LTAB and Mini-LTAB scores represent guiding principles and provide clinically useful tools for the successful selection and utilization of marginal allografts in liver transplantation.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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