Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Division of Trauma and Critical Care Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
PLoS One. 2020 Apr 2;15(4):e0230995. doi: 10.1371/journal.pone.0230995. eCollection 2020.
Historically, liver allografts with >30% macrosteatosis (MaS) on donor biopsy have been associated with early allograft dysfunction and worse graft survival; however, successful outcomes have been reported in small cohorts. This study proposes an elevated MaS threshold for organ utilization without detriment to graft survival.
The UNOS Standard Transplant Analysis and Research database was evaluated for transplants between 2006-2015. Graft survival up to 1-year was evaluated by Kaplan-Meier (KM) survival analyses, and by univariate and multivariable logistic regression analyses, including donor and recipient characteristics. Odds ratios (OR) with 95% confidence intervals (CI) for risk of graft loss are reported.
Thirty-day risk of graft loss was increased with MaS as low as 10-19% (OR [95% CI] 1.301 [1.055-1.605], p<0.0001) and peaked with MaS 50-59% (2.921 [1.672-5.103]). At 1-year, risk of graft loss remained elevated with MaS 40-49% (1.465 [1.002-2.142]) and MaS 50-59% (1.978 [1.281-3.056], p = 0.0224). Multivariable models were created for Lower and Higher MELD recipients and MaS cutoffs were established. In Lower MELD recipients, organs with ≥50% MaS had increased risk of graft loss at 30 days (2.451 [1.541-3.897], p = 0.0008) and 1-year post-transplant (1.720 [1.224-2.418], p = 0.0125). Higher MELD recipients had increased risk of graft loss at 30 days with allografts showing MaS ≥40% (4.204 [1.440-5.076], p = 0.0016). At 1-year the risk remained increased, but MaS was not significant predictor of graft loss.048 [1.131-3.710], p = 0.0616). In both MELD cohorts, organs with MaS levels below threshold had similar survival to those transplanted without a donor biopsy.
In conjunction with recipient selection, organs with MaS up to 50% may be safely used without detriment to outcomes.
历史上，在供体活检中脂肪变性（MaS）>30%的肝移植物与早期移植物功能障碍和移植物存活率降低相关；然而，在小队列中已经报道了成功的结果。本研究提出了一个提高 MaS 阈值以利用器官而不损害移植物存活率的方案。
评估了 2006 年至 2015 年期间 UNOS 标准移植分析和研究数据库中的移植。通过 Kaplan-Meier（KM）生存分析以及单变量和多变量逻辑回归分析评估 1 年时的移植物存活率，包括供体和受体特征。报告了用于移植物丢失风险的比值比（OR）及其 95%置信区间（CI）。
MaS 低至 10-19%（OR [95%CI] 1.301 [1.055-1.605]，p<0.0001）和 MaS 50-59%（2.921 [1.672-5.103]）时，30 天移植物丢失的风险增加。在 1 年时，MaS 40-49%（1.465 [1.002-2.142]）和 MaS 50-59%（1.978 [1.281-3.056]）时，移植物丢失的风险仍然较高（p = 0.0224）。为低和高 MELD 受体创建了多变量模型，并确定了 MaS 截止值。在低 MELD 受体中，MaS≥50%的移植物在 30 天（2.451 [1.541-3.897]，p = 0.0008）和移植后 1 年（1.720 [1.224-2.418]，p = 0.0125）时的移植物丢失风险增加。高 MELD 受体的移植物显示 MaS≥40%时，30 天的移植物丢失风险增加（4.204 [1.440-5.076]，p = 0.0016）。在 1 年时，风险仍然增加，但 MaS 不是移植物丢失的显著预测因子（0.048 [1.131-3.710]，p = 0.0616）。在这两个 MELD 队列中，MaS 水平低于阈值的移植物的存活率与未经供体活检的移植物相似。
结合受体选择，MaS 高达 50%的移植物可安全使用而不会损害结局。
