Fishbein T M, Fiel M I, Emre S, Cubukcu O, Guy S R, Schwartz M E, Miller C M, Sheiner P A
Division of Abdominal Organ Transplantation, The Mount Sinai Medical Center, New York, New York 10029, USA.
Transplantation. 1997 Jul 27;64(2):248-51. doi: 10.1097/00007890-199707270-00012.
The safety of transplanting livers with moderate to severe microvesicular steatosis is unknown. Livers that appear fatty are often abandoned at the donor hospital. We have recently used frozen-section biopsy to distinguish between microvesicular and macrovesicular steatosis. We present here our single-center experience with transplantation of 40 allografts with moderate or severe microvesicular steatosis.
We reviewed our data on 426 transplants and identified 40 cases in which the donor liver contained at least 30% microvesicular steatosis. Early graft function, patient and graft survival, and donor risk factors for steatosis were examined, and results in this cohort were compared with results in all other patients who received liver transplants at our center during the same time period. We also analyzed the reliability of donor frozen-section biopsies in quantitating microsteatosis. Persistence of steatosis was assessed on the basis of 1-year follow-up biopsies.
The incidence of primary nonfunction and poor early graft function was 5% and 10%, respectively. One-year patient and graft survival rates were 80% and 72.5%, respectively. Donor obesity and traumatic death were commonly identified risk factors for microvesicular steatosis. Frozen-section biopsy was reliable for pretransplant decision-making about the use of potential grafts, and the steatosis had disappeared from the graft at 1 year in the majority of cases.
Livers with even severe microvesicular steatosis can be reliably used for transplantation without the fear of high rates of primary nonfunction. There was a significant incidence of poor early graft function, but this did not affect outcome. Microsteatosis is usually associated with some underlying risk factor in the donor and is reversible, as demonstrated by follow-up biopsies after transplant.
移植伴有中度至重度微泡性脂肪变性的肝脏的安全性尚不清楚。外观呈脂肪肝的肝脏通常在供体医院被废弃。我们最近使用冰冻切片活检来区分微泡性和大泡性脂肪变性。在此，我们介绍我们单中心移植40例伴有中度或重度微泡性脂肪变性同种异体肝脏的经验。
我们回顾了426例移植的数据，确定了40例供体肝脏含有至少30%微泡性脂肪变性的病例。检查早期移植物功能、患者和移植物存活率以及脂肪变性的供体风险因素，并将该队列的结果与同期在我们中心接受肝移植的所有其他患者的结果进行比较。我们还分析了供体冰冻切片活检在定量微脂肪变性方面的可靠性。根据1年随访活检评估脂肪变性的持续情况。
原发性无功能和早期移植物功能不良的发生率分别为5%和10%。1年患者和移植物存活率分别为80%和72.5%。供体肥胖和外伤性死亡是常见的微泡性脂肪变性风险因素。冰冻切片活检对于移植前关于潜在移植物使用的决策是可靠的，并且在大多数病例中，1年后移植物中的脂肪变性已消失。
即使是伴有严重微泡性脂肪变性的肝脏也可可靠地用于移植，而无需担心原发性无功能的高发生率。早期移植物功能不良的发生率较高，但这并未影响结果。微脂肪变性通常与供体的一些潜在风险因素相关，并且如移植后随访活检所示是可逆的。
