Impact of Graft Steatosis on Postoperative Complications after Liver Transplantation

Emad Ali Ahmed; Ashraf Mohammad El-Badry; Federico Mocchegiani; Roberto Montalti; Asem Elsani Ali Hassan; Alaa Ahmed Redwan; Marco Vivarelli

doi:10.1055/s-0038-1675236

The Surgery Journal, Table of Contents

CC BY 4.0 · Surg J (N Y) 2018; 04(04): e188-e196
DOI: 10.1055/s-0038-1675236

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Graft Steatosis on Postoperative Complications after Liver Transplantation

Emad Ali Ahmed

¹Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy

²Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt

,

Ashraf Mohammad El-Badry

²Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt

,

Federico Mocchegiani

¹Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy

,

Roberto Montalti

¹Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy

,

Asem Elsani Ali Hassan

²Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt

,

Alaa Ahmed Redwan

²Division of Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, University of Sohag, Sohag, Egypt

,

Marco Vivarelli

¹Division of Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy

› Author Affiliations

Abstract

Background Steatotic grafts are more susceptible to ischemia-reperfusion injury than are normal grafts. Therefore, using steatotic grafts for liver transplantation (LT) is associated with high primary dysfunction and decreased survival rates. The aim of this study is to evaluate the impact of graft steatosis on post LT outcomes.

Methods A retrospective cohort analysis of 271 LT recipients from 2005 to 2016 was performed and patients were classified based on two types of steatosis, macrosteatosis (MaS), and microsteatosis (MiS). Each category was subdivided into three groups according to the degree of steatosis: no (< 5%), mild (≥5 to < 30%), and moderate (≥30 to ≤60%). The primary hospital stays and 6-month postoperative complications were analyzed by the Clavien–Dindo classification system. Additionally, patient and graft survivals were studied.

Results Significant differences were observed in grade III MaS (p-value = 0.019) and grade V MiS (p-value = 0.020). A high trend of early graft dysfunction was found in the moderate MaS and MiS groups; however, they were not statistically significant (p-value = 0.199 and 0.282, respectively). Interestingly, the acute cellular rejection (ACR) rate was found to be inversely proportional to the degree of steatosis in both categories but it did not reach a significant level (p-value = 0.161 and 0.111, respectively).

Conclusion Excellent post LT long-term outcomes using grafts with mild and moderate steatosis were determined. Further studies are needed to evaluate the newly proposed relationship between ACR and steatosis.

Keywords

graft steatosis - fatty liver - liver transplantation - macrosteatosis - microsteatosis - reperfusion injury

Full Text

References

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