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. 2022 Jan 13;8(2):e1280.
doi: 10.1097/TXD.0000000000001280. eCollection 2022 Feb.

A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

Justin A Steggerda  1 , Daniel Borja-Cacho  1 , Todd V Brennan  2 , Tsuyoshi Todo  2 , Nicholas N Nissen  2 , Matthew B Bloom  3 , Andrew S Klein  2 , Irene K Kim  2
Affiliations

A Clinical Tool to Guide Selection and Utilization of Marginal Donor Livers With Graft Steatosis in Liver Transplantation

Justin A Steggerda et al. Transplant Direct. .

Abstract

Background: Donor liver biopsy (DLBx) in liver transplantation provides information on allograft quality; however, predicting outcomes from these allografts remains difficult.

Methods: Between 2006 and 2015, 16 691 transplants with DLBx were identified from the Standard Transplant Analysis and Research database. Cox proportional hazard regression analyses identified donor and recipient characteristics associated with 30-d, 90-d, 1-y, and 3-y graft survival. A composite model, the Liver Transplant After Biopsy (LTAB) score, was created. The Mini-LTAB was then derived consisting of only donor age, macrosteatosis on DLBx, recipient model for end-stage liver disease score, and cold ischemic time. Risk groups were identified for each score and graft survival was evaluated. P values <0.05 were considered significant.

Results: The LTAB model used 14 variables and 5 risk groups and identified low-, mild-, moderate-, high-, and severe-risk groups. Compared with moderate-risk recipients, severe-risk recipients had increased risk of graft loss at 30 d (hazard ratio, 3.270; 95% confidence interval, 2.568-4.120) and at 1 y (2.258; 1.928-2.544). The Mini-LTAB model identified low-, moderate-, and high-risk groups. Graft survival in Mini-LTAB high-risk transplants was significantly lower than moderate- or low-risk transplants at all time points.

Conclusions: The LTAB and Mini-LTAB scores represent guiding principles and provide clinically useful tools for the successful selection and utilization of marginal allografts in liver transplantation.

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Figures

FIGURE 1.
FIGURE 1.
Distribution of macrosteatosis in test and validate cohorts. The distribution of macrosteatosis as assessed on donor liver biopsy is shown in test (A) and validate (B) cohorts. Mean with SD, median, and IQRs are reported. IQR, interquartile range.
FIGURE 2.
FIGURE 2.
Distribution of LTAB scores and scoring index in test and validate cohorts. Raw LTAB scores were calculated for all patients in both test and validate cohorts. A natural log modification was applied to produce the LTAB index score with normal distribution. Means, medians, and IQRs are reported for each population. IQR, interquartile range; LTAB, Liver Transplant After Biopsy.
FIGURE 3.
FIGURE 3.
Three-year allograft survival by LTAB risk groups. LTAB risk groups were identified and 3-y graft survival was assessed by Kaplan-Meier survival curves in test cohort (A) and validate cohort (B). Mean graft survival is reported; P value assesses differences in graft survival across risk groups. LTAB, Liver Transplant After Biopsy.
FIGURE 4.
FIGURE 4.
Allograft survival rates by Mini-LTAB score groups. Mini-LTAB scores were divided into 10-point increments and graft survival was assessed between test and validate cohorts at (A) 30 d, (B) 90 d, and (C) 1 y after transplant. There were no significant differences between test and validate cohorts within any score group, at any time point. LTAB, Liver Transplant After Biopsy.
FIGURE 5.
FIGURE 5.
Three-year allograft survival by Mini-LTAB risk groups. Mini-LTAB risk groups were identified and 3-y graft survival was assessed by Kaplan-Meier survival curves in test cohort (A) and validate cohort (B). Mean graft survival is reported; P value assesses differences in graft survival across risk groups. LTAB, Liver Transplant After Biopsy.
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