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. 2023 May 1;29(5):508-520.
doi: 10.1002/lt.26574. Epub 2022 Oct 10.

Viability assessment and transplantation of fatty liver grafts using end-ischemic normothermic machine perfusion

Damiano Patrono  1 , Riccardo De Carlis  2 , Alessandro Gambella  3 , Francesca Farnesi  1 , Alice Podestà  2   4 , Andrea Lauterio  2   4 , Francesco Tandoi  1 , Luciano De Carlis  2   4 , Renato Romagnoli  1
Affiliations

Viability assessment and transplantation of fatty liver grafts using end-ischemic normothermic machine perfusion

Damiano Patrono et al. Liver Transpl. .

Abstract

End-ischemic viability testing by normothermic machine perfusion (NMP) represents an effective strategy to recover liver grafts having initially been discarded for liver transplantation (LT). However, its results in the setting of significant (≥30%) macrovesicular steatosis (MaS) have not been specifically assessed. Prospectively maintained databases at two high-volume LT centers in Northern Italy were searched to identify cases of end-ischemic NMP performed to test the viability of livers with MaS ≥ 30% in the period from January 2019 to January 2022. A total of 14 cases were retrieved, representing 57.9% of NMP and 5.7% of all machine perfusion procedures. Of those patients, 10 (71%) received transplants. Two patients developed primary nonfunction (PNF) and required urgent re-LT, and both were characterized by incomplete or suboptimal lactate clearance during NMP. PNF cases were also characterized by higher perfusate transaminases, lower hepatic artery and portal vein flows at 2 h, and a lack of glucose metabolism in one case. The remaining eight patients showed good liver function (Liver Graft Assessment Following Transplantation risk score, -1.9 [risk, 13.6%]; Early Allograft Failure Simplified Estimation score, -3.7 [risk, 2.6%]) and had a favorable postoperative course. Overall, NMP allowed successful transplantation of 57% of livers with moderate-to-severe MaS. Our findings suggest that prolonged observation (≥6 h) might be required for steatotic livers and that stable lactate clearance is a fundamental prerequisite for their use.

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Conflict of interest statement

Renato Romagnoli advises for Biotest Italia and consults for Kedrion Biopharma.

Figures

FIGURE 1
FIGURE 1
Histology of transplanted livers before NMP. Livers marked with an asterisk were those developing PNF. All cases presented with large‐droplet steatosis, whereas the tx_1 case was also characterized by a scattered sinusoidal dilation.
FIGURE 2
FIGURE 2
Histology of discarded livers before NMP
FIGURE 3
FIGURE 3
Perfusate parameters during NMP according to use and outcome. In the third and fourth columns, the lines and vertical error bars represent medians and IQRs at different time points during NMP. Abbreviations: ', minutes; h, hours.
FIGURE 4
FIGURE 4
The 2‐h and 4‐h perfusate transaminases according to liver outcome
See this image and copyright information in PMC

Comment in

References

    1. Attia M, Silva MA, Mirza DF. The marginal liver donor an update. Transpl Int. 2008;21:713–24. - PubMed
    1. Feng S, Goodrich NP, Bragg‐Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. . Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6(4):783–90. - PubMed
    1. Croome KP, Lee DD, Taner CB. The "Skinny" on assessment and utilization of steatotic liver grafts: a systematic review. Liver Transpl. 2019;25:488–99. - PubMed
    1. El‐Badry AM, Breitenstein S, Jochum W, Washington K, Paradis V, Rubbia‐Brandt L, et al. . Assessment of hepatic steatosis by expert pathologists: the end of a gold standard. Ann Surg. 2009;250:691–7. - PubMed
    1. Briceno J, Padillo J, Rufian S, Solorzano G, Pera C. Assignment of steatotic livers by the Mayo model for end‐stage liver disease. Transpl Int. 2005;18:577–83. - PubMed