Background: The obesity epidemic has led to an increase in the frequency with which steatotic donor livers are encountered. The usage of steatotic livers from DCD donors has generally been avoided due to the potential for additive risk. There exists a paucity of data investigating the outcomes with transplantation using steatotic DCD livers.
Methods: DCD liver transplants (N=383) performed at Mayo Clinic Florida between 1998-2018 were analyzed. Routine donor allograft biopsies were performed and were read by liver specific pathologists at Mayo Clinic. Patients were divided into groups based on the degree of macrosteatosis: Moderate Macrosteatosis (30-60%), Mild Macrosteatosis (10-29%) and No Steatosis.
Results: Donor and recipient characteristics were similar between groups. Primary non function (PNF) was significantly higher for patients in the DCD Moderate Macrosteatosis group (16.7%) compared to the DCD No Steatosis group (1.2%) (p<0.001). No difference in PNF was seen between the DCD Mild Macroteatosis (0%) and No Steatosis groups (1.2%) (p=0.54). No differences in overall biliary complication or ischemic cholangiopathy were seen between the three groups. No difference in patient (p=0.65) or graft survival (p=0.62) was seen between the three groups.
Conclusions: Liver Transplantation utilizing DCD liver with mild macrosteatosis (<30%) results in no increase in complications and similar patient and graft survival to DCD livers with no steatosis. DCD livers with moderate macrosteatosis (≥ 30%) resulted in higher rates of PNF. Caution should be taken when utilizing DCD livers with ≥30% macrosteatosis.