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Donor Graft Steatosis Associated With Worse Prognosis in Patients With HCV HOBOKEN, NJ -- January 14, 2009 -- Patients with hepatitis C (HCV) who need a liver transplant should not receive an organ with high levels of fatty deposits, according to a study published in the January issue of Liver Transplantation. HCV recurrence was more frequent and earlier among those transplanted with such livers. Javier Briceño and Ruben Ciria, Hepatobiliary Surgery and Liver Transplantation, Reina Sofía University Hospital, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas CiberEHD, Córdoba, Spain, and colleagues sought to determine the influence of donor liver steatosis on outcomes for HCV patients who received them. They included 120 patients who underwent liver transplantation as a result of HCV-cirrhosis between 1995 and 2005. Donor steatosis was categorised as absent (0%-10%), mild (10%-30%), moderate (30%-60%), or severe (>60%). "Our results show a direct relationship between marginal donor, graft steatosis, and a more frequent, severe, and earlier viral recurrence after orthotopic liver transplantation for HCV-related cirrhosis," the authors said. Patient survival was significantly worse when graft steatosis was 30% or more. Survival of the graft was inversely proportional to donor liver steatosis. After 3 years, graft survival was 72% for transplant recipients whose donor livers had no steatosis, 58% for mild, 43% for moderate, and 42% for severe. The most profound decline in graft survival occurred when donor livers contained greater than 30% steatosis and were subjected to more than 12 hours of cold ischaemic time. The authors compared their results with outcomes of liver transplantations in individuals with alcohol-induced cirrhosis, as opposed to HCV. They found that donor steatosis greater than 30% did not reduce graft survival in these non-HCV patients. "Further multicentre studies and a global consensus may be necessary to finally assess if the use of expanded criteria grafts is safe into HCV-positive recipients, as well as if nowadays the organ allocation system should need a change for this cohort of patients," they concluded. In an accompanying editorial, Mitchell Shiffman and Nevin Yilmaz, Virginia Commonwealth University Medical Center, Richmond, Virginia, raise concerns about the study's conclusions. They point out that all patients did not undergo liver biopsies at specified time intervals, and there were not enough data on the patients with alcohol-induced cirrhosis to be sure that the populations were comparable. Still, they were intrigued by the observation that the combination of donor graft steatosis and a prolongation in cold ischaemic time was associated with severe reperfusion injury. "We strongly suggest that cold ischaemia time should be limited when the donor graft contains greater than 30% steatosis and such grafts should only be utilised with caution for patients with chronic HCV," they concluded. SOURCE: Wiley-Blackwell Publishing E-mail this page to a friend or colleague! To print, use this version