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

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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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

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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.

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    Authors and Affiliations

    1. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

      Michael J. J. Chu, Anna J. Dare, Anthony R. J. Phillips & Adam S. J. R. Bartlett

    2. New Zealand Liver Transplant Unit (NZLTU), Auckland City Hospital, Auckland, New Zealand

      Anthony R. J. Phillips & Adam S. J. R. Bartlett

    3. Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand

      Anthony R. J. Phillips & Adam S. J. R. Bartlett

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    1. Michael J. J. Chu
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    2. Anna J. Dare
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    Correspondence to Michael J. J. Chu.

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    Michael J. J. Chu and Anna J. Dare contributed equally to this work.

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    Chu, M.J.J., Dare, A.J., Phillips, A.R.J. et al. Donor Hepatic Steatosis and Outcome After Liver Transplantation: a Systematic Review. J Gastrointest Surg 19, 1713–1724 (2015). https://doi.org/10.1007/s11605-015-2832-1

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