Marginal grafts: finding the correct treatment for fatty livers

The influence of steatosis on the outcome of orthotopic liver transplantation (OLT) was evaluated in 860 liver transplantations carried out in 784 patients from October 1990 to August 2001. Donor variables considered were: age, hepatic enzymes, bilirubin, total and warm ischemia times, macrovesicular and microvesicular steatosis. Recipient variables considered were: age, UNOS status, Child-Pugh score and indication for OLT. Patient and graft survival were the main outcome indicators. Macrovesicular steatosis affecting 15% or more of the hepatocytes was the only variable independently associated with shorter patient and graft survival (P=0.0012 and 0.0028). A significantly worse prognosis was to be expected if >15% macrovesicular steatosis was associated with a total ischemia time >10 h (P=0.048), or donor age >65 years (P=0.016) or with HCV-positive recipients (P=0.0014). From our study we can conclude that macrovesicular steatosis involving 15% or more of the hepatocytes identifies marginal livers. The risk of graft non-function or patient loss after OLT rises if macrovesicular steatosis >15% is associated with long ischemia time, high donor age, or HCV positivity in recipients.