The Liver Biopsy During Organ Procurement

Hepatic steatosis is a commonly noticed and most prevalent condition among donated liver grafts. The pressing demand for organs and increased patient death rates while awaiting organ transplantation has led to the use of cadaveric livers with hepatic steatosis for transplantation. Recent data reported the use of steatotic liver grafts in 71% of cases (Noujaim et al., 2009). Moreover, to meet the organ shortage, the criteria for donation have been broadened to include donors with advanced age, hepatitis B and C viruses, neoplasms, and benign underlying diseases (Fondevila et al., 2009). The use of expanded-criteria donors (ECDs) and the donor risk index (DRI) are strategies that have been proposed to increase the donor pool (Feng et al., 2006). The Donor Risk Index (DRI) lists seven donor characteristics, together with cold ischemia time and location of the donor as risk factors for graft failure. DRI >1.7 is reported to be associated with shorter survival after liver transplantation (Palmiero et al., 2010). It is hypothesized that donor hepatic steatosis is an additional independent risk factor (Spitzer et al., 2010). It remains unclear which value micro and/ or macrovesicular steatosis have for the short and long term results after liver transplantation. Therefore, different papers report a safe use of grafts with a severe microvesicular steatosis (Fishbein et al., 1997; McCormack et al., 2007). However, steatosis is one of the most important factors affecting liver allograft function. Steatosis is common in several situations, including: obesity, diabetes, and alcohol abuse (Durand et al., 2008). Organ donation predictive factors for recipient survival were: age, viral status, and degree of liver steatosis. Liver transplantation for alcoholic liver disease showed the highest complication rate. Chronic liver rejection occurred more frequently in the AIH transplanted group. The most useful predictive factors for 1-year survival were urea/ creatinine and liver function tests. (Patkowski et al., 2009). In addition, transplantation of a liver with >25% steatosis was a risk factor for the development of a biliary complication (Baccarani et al., 2009). Nevertheless, macrovesicular steatosis is known as a risk factor for early graft dysfunction and graft failure. Most transplantation centres consider 60% the value limit for transplantability, while others have adopted 30% as a cut-off limit (D'Alessandro et al., 2010). Organ donor shortage continues to pose a significant problem. To ensure fair and transparent allocation of too few post-mortem grafts, the model of end-stage liver disease (MELD)-based allocation was implemented in the Eurotransplant area in December 2006. This has decreased the waiting list mortality rate from 20 to 10 %, but at the same time has reduced post OLT survival (1-year survival from almost 90% to below 80%), which is largely