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Journal of Gastrointestinal Surgery

, Volume 19, Issue 9, pp 1713–1724 | Cite as

Donor Hepatic Steatosis and Outcome After Liver Transplantation: a Systematic Review

  • Michael J. J. ChuEmail author
  • Anna J. Dare
  • Anthony R. J. Phillips
  • Adam S. J. R. Bartlett
Review Article

Abstract

Background

There is increasing need to expand availability of donor liver grafts, including steatotic livers. Steatotic liver is associated with poor outcome post-transplantation but with conflicting results in the literature. The aim of this systematic review was to evaluate the impact of steatotic livers on liver transplantation outcomes.

Methods

An electronic search of OVID Medline and Embase databases was performed to identify clinical studies that reported outcomes of steatotic livers in liver transplantation. Data were extracted, and basic descriptive statistics were used to summarise data pooled from individual clinical studies.

Results

Ninety-two articles were identified, of which 34 met the inclusion criteria, and stratified analysis were performed. There was a lack of standardised definition of primary non-function or impaired primary function amongst the studies and description of type of steatosis. Severely (>60 %) steatotic grafts are associated with increased risk of poor graft function, whilst moderate–severe (>30 %) steatotic grafts are associated with decreased graft survival.

Conclusions

Available evidence showed increased risk of poor graft outcome in moderate–severe steatotic livers. A large prospective multi-centred trial will be required to identify the true risks of steatotic livers. Consistent definition of primary non-function/impaired primary function and description of type of steatosis is also required.

Keywords

Fatty liver Graft survival Humans Survival rate Treatment outcome 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

CaCo

Case–control study

CaR

Case report

Co

Cohort study

DCD

Donation after circulatory death

DNF

Delayed non-function

EAD

Early allograft dysfunction

ECD

Extended criteria donor

EGD

Early graft dysfunction

INR

International normalised ratio

IPF

Impaired primary function

MELD

Model for End-Stage Liver Disease

ns

Not stated

OLT

Orthotopic liver transplantation

P

Prospective

PDF

Primary dysfunction of graft

PNF

Primary non-function

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-analyses

PT

Prothrombin time

PTA

Prothrombin time activity

PTT

Partial thromboplastin time

Re

Retrospective

RR

Relative risk

SGOT

Serum glutamic oxaloacetic transaminases

Notes

Acknowledgements

This work was directly supported by the University of Auckland Faculty Research Development Fund, Maurice Wilkins Centre for Biodiscovery and the Maurice & Phyllis Paykel Trust.

Supplementary material

11605_2015_2832_MOESM1_ESM.docx (626 kb)
Table S1 (DOCX 625 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Michael J. J. Chu
    • 1
    Email author
  • Anna J. Dare
    • 1
  • Anthony R. J. Phillips
    • 1
    • 2
    • 3
  • Adam S. J. R. Bartlett
    • 1
    • 2
    • 3
  1. 1.Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.New Zealand Liver Transplant Unit (NZLTU)Auckland City HospitalAucklandNew Zealand
  3. 3.Maurice Wilkins Centre for Molecular BiodiscoveryUniversity of AucklandAucklandNew Zealand

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