Chu Michael J J, Dare Anna J, Phillips Anthony R J, Bartlett Adam S J R
Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand,
J Gastrointest Surg. 2015 Sep;19(9):1713-24. doi: 10.1007/s11605-015-2832-1. Epub 2015 Apr 28.
There is increasing need to expand availability of donor liver grafts, including steatotic livers. Steatotic liver is associated with poor outcome post-transplantation but with conflicting results in the literature. The aim of this systematic review was to evaluate the impact of steatotic livers on liver transplantation outcomes.
An electronic search of OVID Medline and Embase databases was performed to identify clinical studies that reported outcomes of steatotic livers in liver transplantation. Data were extracted, and basic descriptive statistics were used to summarise data pooled from individual clinical studies.
Ninety-two articles were identified, of which 34 met the inclusion criteria, and stratified analysis were performed. There was a lack of standardised definition of primary non-function or impaired primary function amongst the studies and description of type of steatosis. Severely (>60%) steatotic grafts are associated with increased risk of poor graft function, whilst moderate-severe (>30%) steatotic grafts are associated with decreased graft survival.
Available evidence showed increased risk of poor graft outcome in moderate-severe steatotic livers. A large prospective multi-centred trial will be required to identify the true risks of steatotic livers. Consistent definition of primary non-function/impaired primary function and description of type of steatosis is also required.
扩大供体肝移植的可及性需求日益增加，包括脂肪变性肝脏。脂肪变性肝脏与移植后不良预后相关，但文献结果存在矛盾。本系统评价的目的是评估脂肪变性肝脏对肝移植结局的影响。
对OVID Medline和Embase数据库进行电子检索，以识别报告肝移植中脂肪变性肝脏结局的临床研究。提取数据，并使用基本描述性统计方法总结从各个临床研究汇总的数据。
共识别出92篇文章，其中34篇符合纳入标准，并进行了分层分析。研究中缺乏原发性无功能或原发性功能受损的标准化定义以及脂肪变性类型的描述。严重（>60%）脂肪变性移植物与移植物功能不良风险增加相关，而中重度（>30%）脂肪变性移植物与移植物存活率降低相关。
现有证据表明，中重度脂肪变性肝脏的移植物不良结局风险增加。需要进行一项大型前瞻性多中心试验，以确定脂肪变性肝脏的真正风险。还需要对原发性无功能/原发性功能受损进行一致定义，并描述脂肪变性类型。
