Urena M A, Moreno Gonzalez E, Romero C J, Ruiz-Delgado F C, Moreno Sanz C
Hepatogastroenterology. 1999 Mar-Apr;46(26):1164-73.
Steatosis or fatty change is a common finding in donor liver biopsies during liver transplantation, and seems to be more frequent than in the general population. Fat can be stored in hepatocytes within macrovacuoles (macrosteatosis) or microvacuoles (microsteatosis), with different degrees of severity. Higher degrees of both macro and microsteatosis may increase the severity of the ischemia-reperfusion lesion producing an initial poor function in the recipient. Different pathogenic mechanisms have been investigated. However, only severe macrosteatotic (> 60%) grafts have been associated with primary non-function, and are universally rejected for transplantation. While donor livers with any severity of microsteatosis do not influence recipient survival and can be safely implanted, donor livers with moderate to severe macrosteatosis (30-60%) have a relative risk of primary non-function and should be considered for transplantation in the absence of other known risk factors. A protocol with a rational use of these steatotic livers is suggested.
脂肪变性或脂肪变是肝移植供体肝活检中的常见发现，且似乎比普通人群中更为常见。脂肪可储存在肝细胞内的大空泡（大脂肪变）或微空泡（微脂肪变）中，程度各异。大脂肪变和微脂肪变的严重程度越高，缺血再灌注损伤的严重程度可能就越高，导致受体最初功能不佳。人们已经研究了不同的致病机制。然而，只有严重的大脂肪变（>60%）移植物与原发性无功能相关，并且普遍被拒绝用于移植。虽然任何严重程度的微脂肪变供体肝不影响受体存活，可安全植入，但中度至重度大脂肪变（30 - 60%）的供体肝存在原发性无功能的相对风险，在没有其他已知风险因素的情况下应考虑用于移植。建议采用合理使用这些脂肪变性肝脏的方案。
