Date: Saturday, May 30, 2020
Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD) I
Session Time: 3:15pm-4:45pm
Presentation Time: 3:51pm-4:03pm
*Purpose: Given the potentially additive risk from using donor livers that are both steatotic and from a donation after circulatory death(DCD) donor, there is a paucity of data on the outcome of DCD liver transplantation(LT) utilizing livers with macrosteatosis.The present study involves three large volume DCD centers that have increasingly utilized steatotic DCD livers over time.
*Methods: All DCD LT performed at Mayo Clinic-Florida(MCF), Mayo Clinic-Arizona(MCA) and Mayo Clinic-Rochester(MCR) from 1999-2019 were included(N=714). Recipients of DCD LT were divided into 3 groups: those with Moderate Macrosteatosis(30-60%), Mild Macrosteatosis(5-30%) and No Steatosis. All liver biopsies were evaluated by an experienced liver pathologist at MCF, MCA or MCR.
*Results: Patients with Moderate Macrosteatosis had a higher rate of post-reperfusion syndrome (PRS)(53.9% vs. 26%;p=0.01), post-reperfusion cardiac arrest(7.7% vs.0.3%;p<0.001), primary non-function(PNF)(7.7%vs.1.0%;p=0.003), early allograft dysfunction(EAD)(70.8%vs.45.6% and 8.3%;p=0.02) and acute kidney injury (AKI)(39.1%vs.19.4%; p=0.02) than patients with No Steatosis. No difference in any of the peri-operative complications was seen between the Mild Macrosteatosis and the No Steatosis groups except for the rate of EAD(56.8%vs.45.6%;p=0.04). No difference in ischemic cholangiopathy(IC), vascular thrombosis/stenosis or graft and patient survival was seen between the three groups.
*Conclusions: DCD donors with mild macrosteatosis <30% can be utilized with no increase in peri-operative complications and similar patient and graft survival compared to DCD donors with no steatosis. When utilizing DCD donors with moderate macrosteatosis (30-60%), higher rates of PRS, PNF, post-reperfusion cardiac arrest, EAD and AKI should be anticipated. If recipients are able to tolerate these peri-operative events, a similar long-term patient and graft survival compared to DCD livers with no steatosis can potentially be achieved. In addition, donor steatosis does not appear to be correlated with the rate of post-LT IC.
To cite this abstract in AMA style:Croome K, Mathur A, Mao S, Aqel B, Senada P, Piatt J, Heimbach J, Moss A, Rosen C, Taner C. What Are the Peri-Operative and Longterm Outcomes of Utilizing Donation after Circulatory Death Livers with Macrosteatosis? A Multicenter Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/what-are-the-peri-operative-and-longterm-outcomes-of-utilizing-donation-after-circulatory-death-livers-with-macrosteatosis-a-multicenter-analysis/. Accessed January 20, 2021.
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