Postperfusion energy metabolism of steatotic graft and its relation to early graft viability following liver transplantation.

The present study was designed to assess energymetabolism of steatotic grafts and to determine itsrelation to early graft viability. Graft biopsies weretaken, and the triglyceride content was determined in 29 grafts for the assessment of steatosis.The peak aspartate aminotransferase level and theconcentrations of lactate and pyruvate were stronglycorrelated with the triglyceride content, suggesting that steatotic grafts are more vulnerable topreservation or reperfusion injury and that glucoseoxidation is inhibited postoperatively in the steatoticgrafts. Ketogenesis, an alternative pathway to produce energy substrates, was not accelerated evenwhen the steatotic grafts produced more free carnitineto enhance the beta-oxidation of fatty acids. Thedeterioration of energy metabolism was associated with the increase in prothrombin time ratio,hepatocyte growth factor, and hyaluronic acid thatreflected graft viability. Deterioration ofpostperfusion energy metabolism in the steatotic graftsmay be involved in the development of irreversible graftdamage.