Westerkamp, A. (Andrie) (2012) Similar Outcome After Transplantation of Moderate Macrovesicular Steatotic or Non-steatotic Livers When The Cold Ischemia Time Is Kept Very Short. thesis, Medicine.
Full text available on request.Abstract
Background: Livers with moderate (30%-60%) or severe (>60%) macrovesicular steatosis are associated with poor outcome after transplantation due to an increased susceptibility for ischemia/reperfusion (I/R) injury. For this reason, many centers do not accept these livers for transplantation. However, the use of very strict logistics to keep the cold ischemia time (CIT) very short might still result in acceptable results. Aim of this study was to examine outcome after transplantation of livers with moderate macrovesicular steatosis when the CIT is kept very short. Methods: Between January 2000 and December 2010, nineteen adult patients received a liver with moderate steatosis. Outcome in the recipients of a liver with moderate steatosis was compared with outcome in a matched control group of 76 patients (1:4 ratio) who received a non-steatotic liver in the same period. Groups were matched for recipient age, body mass index, cold ischemia time, MELD (model for end-stage liver disease) score, and status on the waiting list. Primary endpoints were graft and patient survival. Secondary endpoints were primary non-function (PNF), postoperative complications (hepatic artery thrombosis, bile duct strictures, intra abdominal infections), need for dialysis, hospital/IC stay, need for retransplantation, and steatotic reversal in follow-up liver biopsies. Results: Mean CIT in livers with moderate steatosis and in controls was 7:29 hr and 7:24 hr, respectively. Short and long-term patient and graft survival rates were similar between the moderate steatotic group and the control group. Although serum markers of I/R injury were significantly higher in patients who received a steatotic grafts, there were no significant differences in the incidence of PNF and postoperative complications. Reversal of steatosis was seen in 9 of the 11 (82%) follow-up liver biopsies. Conclusion: Although livers with moderate steatosis are more prone to I/R injury, these livers can still be successfully used for transplantation when a very strict protocol is used to keep the CIT as short as possible (preferably <8 hr). Such a protocol should include careful recipient selection (e.g. no late retransplants) as well as strict logistics to avoid delay between procurement and transplantation. The use of moderate steatotic livers under these conditions is a safe way to expand the donor pool.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Porte, dr. prof. R.J. and Section of Hepatobiliary Surgery and Liver Transplantation |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1358 |
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