Donation after cardiac death liver transplantation: Graft quality evaluation based on pretransplant liver biopsy

Donation after cardiac death (DCD) liver grafts are associated with inferior clinical outcomes and high discard rates because of poor graft quality. We investigated the predictive value of DCD liver biopsy for the pretransplant graft quality evaluation. DCD liver transplants that took place between October 2010 and April 2014 were included (n=127). Histological features of graft biopsy samples were analyzed to assess risk factors for graft survival. Macrovesicular steatosis20% [hazard ratio (HR)=2.973; P=0.045] and sinusoidal neutrophilic infiltrate (HR=6.969; P=0.005) were confirmed as independent risk factors for graft survival; hepatocellular swelling, vacuolation, and necrosis failed to show prognostic value. Additionally, a donor serum total bilirubin level34.2 mol/L was also associated with a lower probability of graft survival. Our analysis indicates that macrovesicular steatosis20% and sinusoidal neutrophilic infiltrate are novel and useful histological markers for DCD liver grafts with unacceptable quality. This finding can be used by transplant surgeons to improve DCD liver acceptance protocols. Liver Transpl 21:838-846, 2015. (c) 2015 AASLD.