Selectively Transplanting Moderately to Severely Macrosteatotic Grafts: Does Recipient Metabolic Environment Affect Outcomes?
Department of Surgery, Thomas Jefferson University, Philadelphia, PA
Meeting: 2020 American Transplant Congress
Abstract number: 44
Keywords: Donors, marginal, Dyslipidemia, Liver grafts, Metabolic disease
Session Information
Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD) I
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 4:03pm-4:15pm
Location: Virtual
*Purpose: As incidence of Non-Alcoholic Steatohepatitis (NASH) cirrhosis rises, organ utilization remains stagnant. Recently, it has been shown that selective utilization of >30% macrosteatotic grafts can produce acceptable graft outcomes. We examine the effects of utilizing similarly metabolically impaired macrosteatotic donor grafts in NASH compared with non-NASH counterparts.
*Methods: Retrospective analysis of the Organ Procurement and Transplantation Network database from 2002 to 2019 identified 2,295 patients receiving >30% macrosteatotic grafts. Patients were stratified by diagnosis of NASH. Kaplan-Meier curves assessed survival with Cox proportional hazard and stratified log-rank tests assessing equality of survivor functions. Propensity score matching (PSM) addressed confounding variables.
*Results: NASH patients had higher unadjusted MELD scores (20 vs. 18, p<0.040), BMI (32 vs. 27, p<0.001), prevalence of diabetes (58.4% vs. 21.3%, p<0.001), portal vein thrombosis (PVT, 18.9 vs. 11.2%, p<0.001), and renal failure requiring dialysis (11.2% vs. 7.9%, p=0.046). PSM mitigated differences across MELD score, PVT, and renal failure, although trends in BMI and diabetes prevalence remained significant. PSM 1, 3 and 5-year patient survival were similar across NASH and non-NASH cohorts. Graft survival was similar at 1 and 3 years; however, NASH patients demonstrated significant improvement at 5 years. No difference was noted in mortality or graft failure on subgroup analysis including primary non-function (Figure 1).
*Conclusions: Despite differences in baseline characteristics and a more globally compromised profile, NASH patients tolerate macrosteatotic grafts as well as non-NASH counterparts. When matched, NASH demonstrated better 5-year survival with these grafts. Historically, transplants with >30% macrosteatotic grafts portend worse outcomes; short and long-term data here demonstrates these grafts have reasonable outcomes in populations with low incidences of primary non-function. These grafts can be safe to use in carefully selected donors in both NASH and non-NASH recipients.
| PSM Baseline Characteristics | NASH | Non-NASH | p-value | PSM Outcomes | NASH | Non-NASH | p-value |
| Age | 60 (55-65) | 60 (52-64) | 0.065 | Survival: 1 year | 308 (88.51%) | 198 (90.00%) | 0.679 |
| BMI | 32.1 (+/- 5.4) | 27.9 (+/- 5.5) | <0.001 | 3 years | 301 (86.49%) | 185 (84.09%) | 0.463 |
| Donor BMI | 33.6 (+/- 7.9) | 32.2 (+/- 7.8) | 0.041 | 5 years | 295 (84.77%) | 175 (79.55%) | 0.112 |
| MELD | 20 (15-25) | 20 (15-26) | 0.649 | Graft Survival: 1 year | 301 (86.49%) | 189 (85.91%) | 0.844 |
| Diabetes | 193 (58.31%) | 40 (18.86%) | <0.001 | 3 years | 294 (84.48%) | 174 (79.09%) | 0.113 |
| Renal Failure on Dialysis | 39 (11.21%) | 23 (10.45%) | 0.780 | 5 years | 288 (82.76%) | 163 (74.09%) | 0.013 |
| Portal Vein Thrombosis | 66 (19.02%) | 42 (19.18%) | 0.963 | Graft Primary Non-Function | 5 (1.44%) | 6 (2.73%) | 0.278 |
To cite this abstract in AMA style:
Altshuler PJ, Diaz ARios, Shaheen O, Shah AP, Maley WR, Frank A, Ramirez C, Glorioso J, Dang H, Bodzin AS. Selectively Transplanting Moderately to Severely Macrosteatotic Grafts: Does Recipient Metabolic Environment Affect Outcomes? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/selectively-transplanting-moderately-to-severely-macrosteatotic-grafts-does-recipient-metabolic-environment-affect-outcomes/. Accessed November 24, 2024.« Back to 2020 American Transplant Congress