The Use of Fatty Liver Grafts in Modern Allocation Systems Risk Assessment by the Balance of Risk (BAR) Score

被引:143
作者
Dutkowski, Philipp [1 ]
Schlegel, Andrea [1 ]
Slankamenac, Ksenija [1 ]
Oberkofler, Christian E.
Adam, Rene [3 ]
Burroughs, Andrew K. [4 ,5 ,6 ]
Schadde, Eric [1 ]
Muellhaupt, Beat [2 ]
Clavien, Pierre-Alain [1 ]
机构
[1] Univ Zurich Hosp, Dept Surg, Swiss HPB & Transplant Ctr, CH-8091 Zurich, Switzerland
[2] Univ Zurich Hosp, Dept Gastroenterol & Hepatol, Zurich, Switzerland
[3] Paris S Univ, Paul Brousse Hosp, Hepato Biliary Ctr, Villejuif, France
[4] Royal Free Hosp, Royal Free Sheila Sherlock Liver Ctr, London, England
[5] UCL, London WC1E 6BT, England
[6] European Liver & Intestine Transplant Assoc, Birmingham, W Midlands, England
关键词
liver transplantation; macrosteatotic liver; microsteatotic liver; risk adjustment; HEPATOCELLULAR-CARCINOMA; HEPATIC STEATOSIS; SURVIVAL BENEFIT; TRANSPLANTATION; DISEASE; UTILITY; MACROSTEATOSIS; FAILURE; INJURY; MELD;
D O I
10.1097/SLA.0b013e318272dea2
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To integrate the amount of hepatic steatosis in modern liver allocation models. Background: The aim of this study was to combine the 2 largest liver transplant databases (United States and Europe) in 1 comprehensive model to predict outcome after liver transplantation, with a novel focus on the impact of the presence of steatosis in the graft. Methods: We adjusted the balance of risk (BAR) score for its application to the European Liver Transplant Registry (ELTR) database containing 11,942 patients. All liver transplants from ELTR and United Network for Organ Sharing with recorded liver biopsies were then combined in one survival analysis in relation to the presence of graft micro- (n = 9,677) and macrosteatosis (n = 11,516). Results: Microsteatosis, regardless of the amount, was associated with a similar relationship between mortality and BAR score as nonsteatotic livers. Low-grade macrosteatotic liver grafts (<= 30% macrosteatosis) resulted in 5-year graft-survival rates of 60% or more up to BAR 18, comparable to nonsteatotic grafts. However, use of moderate or severely steatotic liver grafts (> 30% macrosteatosis) resulted in acceptable outcome only if the cumulative risk at transplant was low, that is, BAR score of 9 or less. Conclusions: Microsteatotic or 30% or less macrosteatotic liver grafts can be used safely up to BAR score of 18 or less, but liver grafts with more than 30% macrosteatotis should be used with risk adjustment, that is, up to BAR score of 9 or less.
引用
收藏
页码:861 / 869
页数:9
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