Visual assessment of liver steatosis at retrieval predicts long term liver transplant outcomes in donation following circulatory death.

Abstract

Background: The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, due to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate the impact of visually assessed liver steatosis in grafts donated following brainstem (DBD) versus circulatory death (DCD).

Methods: NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data and adjusted regression models with interaction terms to compare the impact of visually assessed donor graft steatosis on transplant outcome.

Results: 9217 recipients of deceased donor grafts were included (DBD = 7349; DCD = 1868). Multivariable cox regression revealed that the negative impact on graft survival was significantly different in DCD and DBD livers (interaction P = 0.011 and P = 0.043). The largest impact was in DCD livers (moderate steatosis: aHR = 1.851, 1.296-2.645, P = 0.001 and aHR = 5.426; severe steatosis: 1.723-17.090, P = 0.004). Visually assessed steatosis did not predict longer-term graft survival in the DBD cohort.

Conclusion: The impact of visually assessed steatosis on post-transplant outcome is far greater in DCD grafts, despite an identical method of steatosis assessment. This highlights novel therapeutics should be considered for steatotic DCD grafts to allow this growing sector of the donor pool to be safely utilised.