INTRODUCTION

Graft steatosis is a risk factor for early allograft dysfunction (EAD) and is thought to portend inferior transplant outcomes. The impact of total steatosis, combining percentage of steatosis and graft weight, or total steatotic mass (TSM), has not been determined.

METHODS

Allograft weight and percent steatosis was prospectively collected on 248 adult liver transplants (June 2016–Sept 2017). TSM was calculated by adding the proportional weights of macro and microsteatosis. We defined high TSM grafts as those within the 4^th quartile in the TSM distribution. Patient and graft survival, were studied with log rank test. Spearman correlation coefficients between TSM and postoperative AST, ALT, total bilirubin (Tbili) and INR were calculated. Incidence of EAD (defined as AST≥6000 U/L or ALT≥3000 U/L within the first week, Tbili≥10 mg/dL and/or INR≥1.6 on postoperative day 7) and MELD score on postoperative day 5 (MELD_POD5) were analyzed as markers of graft dysfunction. Predictors of graft dysfunction were studied by uni- and multivariate logistic regression models.

RESULTS

Sixty two grafts were considered high TSM (≥282 gm). Recipients of high TSM livers had significant lower MELD at time of transplant (median MELD 17.5 [14 – 22] vs 19 [14 – 26]; p=0.04), higher donor BMI (p<0.01), donor diabetes (p=0.04) and donor hypertension (p<0.01). We found a positive correlation between TSM and postoperative values of AST and ALT during the first week (p<0.01), and INR in the first 24h after transplant (p<0.01). Consequently, high TSM livers were more commonly associated with EAD (high TSM 21% vs low TSM 9.1%; p=0.02) despite adjusting for preoperative MELD, donor BMI, and total ischemia time (p<0.01). However, TSM was not associated with higher frequency of MELD_POD5>18.9 (high TSM 19.3% vs low TSM 19.9%, p>0.99). Importantly, high TSM was not associated with inferior patient or graft survival (p=0.76 and p=0.45, respectively).

CONCLUSIONS

Although allograft steatosis is correlated with high enzyme release, which is incorporated into current definitions of EAD, our data suggests that it is not the enzyme leak per se that is a factor in graft dysfunction. Our data suggests that it may be other causes of hepatocellular injury, independent of steatosis, that are more relevant to patient and graft outcomes.

CITATION INFORMATION: De Gregorio L., Bugeaud E., Galliano G., Bohorquez H., Bruce D., Carmody I., Cohen A., Seal J., Sonnier D., Mathur A., Loss G. Impact of Total Graft Steatotic Mass in Liver Transplant Outcomes Am J Transplant. 2017;17 (suppl 3).

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