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Transplanted fatty livers associated with worse prognosis for patients with HCV
Date:1/13/2009

livers had no steatosis, 58 percent for mild, 43 percent for moderate and 42 percent for severe. The most profound decline in graft survival occurred when donor livers contained greater than 30 percent steatosis and were subjected to more than 12 hours of cold ischemic time.

The authors compared their results to outcomes of liver transplantations in individuals with alcohol-induced cirrhosis, as opposed to HCV. They found that donor steatosis greater than 30 percent did not reduce graft survival in these non-HCV patients.

"Further multicenter studies and a global consensus may be necessary to finally assess if the use of expanded criteria grafts is safe into HCV-positive recipients, as well as if nowadays the organ allocation system should need a change for this cohort of patients," they conclude.

An accompanying editorial by Mitchell Shiffman and Nevin Yilmaz of Virginia Commonwealth University Medical Center raises concerns about the study's conclusions. It points out that all patients did not undergo liver biopsies at specified time intervals, and there was not enough data on the patients with alcohol-induced cirrhosis to be sure that the populations were comparable.

Still, they were intrigued by the observation that the combination of donor graft steatosis and a prolongation in cold ischemic was associated with severe reperfusion injury.

"We strongly suggest that cold ischemia time should be limited when the donor graft contains greater than 30 percent steatosis and such grafts should only be utilized with caution for patients with chronic HCV," they conclude.


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Contact: Sean Wagner
medicalnews@bos.blackwellpublishing.com
781-388-8550
Wiley-Blackwell
Source:Eurekalert

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