Early Post-Transplant Resolution of Liver Allograft Steatosis and its Impact on Graft Survival

Abstract

Deceased donor liver transplant allografts with steatosis have an increased risk of primary non- function (PNF) and initial poor function (IPF) post-transplant. Previous research suggests a rapid improvement in steatosis in the few days post-transplant. This study compares reperfusion and early post-transplant surveillance biopsies, and compares these results to initial graft function and long-term outcomes. Methods: The records of all liver transplants (LTs) performed over a 9-year period were reviewed. Reperfusion biopsy reports were reviewed and recorded in the transplant center research database. All biopsies were read by experienced liver pathologists from permanent sections taken from the initial post-transplant reperfusion biopsy. A routine follow-up biopsy was obtained 3-5 days post-transplant. Total steatosis included both micro- and macrovesicular and was categorized into four study groups: none (0%), mild (<10%), moderate (10-20%) and severe (>20%). Using Cox proportional hazards an analysis was done to find any correlation between increasing steatosis and overall graft mortality. Results: Data were available for 1155 adult subjects. First week post-transplant liver enzymes demonstrated significantly higher initial alanine amino-transferase (ALT) and total bilirubin (TB) levels with increasing steatosis. These values decreased for all study groups until they were similar by day 7 (ALT) and day 14 (TB). Greater than 20% steatosis had a significantly negative impact on 30-day glomerular filtration rate (GFR) with an initial decrease by 30% within 3 days and an overall reduction of 25% at day 30. From reperfusion to follow-up biopsy, there was a decrease in total steatosis (median) which ranged from 67-100% in those liver allografts with steatosis. Using Cox proportional hazards, there was a clear survival disadvantage at 1-month, 12-months and 60-months for allografts with >10% steatosis. Conclusion: These results confirm a marked post-transplant decrease in allograft steatosis that occurs within 3-5 days of transplant. Initial liver function is delayed in grafts with more steatosis, but is indistinguishable thereafter. Both early and late graft survival is negatively impacted by increasing graft steatosis.