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Donation after cardiac death liver transplantation: Graft quality evaluation based on pretransplant liver biopsy
Author(s) -
Xia Weiliang,
Ke Qinghong,
Wang Ye,
Feng Xiaowen,
Guo Haijun,
Wang Weilin,
Zhang Min,
Shen Yan,
Wu Jian,
Xu Xiao,
Yan Sheng,
Zheng Shusen
Publication year - 2015
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24123
Subject(s) - medicine , liver transplantation , hazard ratio , biopsy , liver biopsy , steatosis , transplantation , surgery , gastroenterology , confidence interval
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 steatosis ≥ 20% [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 level ≥ 34.2 μmol/L was also associated with a lower probability of graft survival. Our analysis indicates that macrovesicular steatosis ≥ 20% 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 . © 2015 AASLD.