Prevalence of Steatosis Hepatis in the Eurotransplant Region: Impact on Graft Acceptance Rates

Abstract

Due to the shortage of liver allografts and the rising prevalence of fatty liver disease in the general population, steatotic liver grafts are considered for transplantation. This condition is an important risk factor for the outcome after transplantation. We here analyze the characteristics of the donor pool offered to the Charité - Universitätsmedizin Berlin from 2010 to 2016 with respect to liver allograft nonacceptance and steatosis hepatis. Of the 2653 organs offered to our center, 19.9% (n=527) were accepted for transplantation, 58.8% (n=1561) were allocated to other centers, and 21.3% (n = 565) were eventually discarded from transplantation. In parallel to an increase of the incidence of steatosis hepatis in the donor pool from 20% in 2010 to 30% in 2016, the acceptance rates for steatotic organs increased in our center from 22.3% to 51.5% in 2016 (p < 0.001), with the majority (86.9%; p > 0.001) having less than 30% macrovesicular steatosis hepatis. However, by 2016, the number of canceled transplantations due to higher grades of steatosis hepatis had significantly increased from 14.7% (n = 15) to 63.6% (42; p < 0.001). The rising prevalence of steatosis hepatis in the donor pool has led to higher acceptance rates of steatotic allografts. Nonetheless, steatosis hepatis remains a predominant phenomenon in discarded organs necessitating future concepts such as organ reconditioning to increase graft utilization.

Figure 1

Organs offered and accepted 2010-2016. (a) All liver allografts offered to our center, accepted and not accepted. (b) All nonaccepted liver allografts, secondary allocation to another center or discarded from allocation.

Figure 2

Age and steatosis as influencing factors of acceptance rates. (a) Significantly higher proportion of discarded liver allografts from senior donors (39.1% ∗∗∗ p < 0.001). (b) Steatosis hepatis is significantly more frequently present in discarded organs (49.7%, ∗∗∗ p < 0.001).

Figure 3

Steatosis hepatis prelavence and influence on acceptance rates. (a) Declining acceptance rate for all liver allografts during study period (∗∗∗ p < 0.001). (b) Significant increase in steatosis hepatis in transplantations in our center (∗∗∗ p < 0.001). (c) Trend in rising steatosis hepatis prevalence in donor population after 2012.

Figure 4

Steatosis hepatis prelavence and influence on graft survival. (a) Increased rates of EAD in steatotic liver grafts (p = 0.013). (b) Kaplan-Meier analysis of graft survival of patients with and without early allograft dysfunction (EAD) (p < 0.001). (c) Kaplan-Meier analysis of graft survival in steatotic liver grafts (p = 0.13). S0, no steatosis; S1, mild steatosis; S2, moderate steatosis; S3, severe steatosis. EAD, early allograft dysfunction.