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The Use of Fatty Liver Grafts in Modern Allocation Systems: Risk Assessment by the Balance of Risk (BAR) Score

Dutkowski, Philipp MD*; Schlegel, Andrea MD*; Slankamenac, Ksenija MC*; Oberkofler, Christian E. MD; Adam, Rene MD; Burroughs, Andrew K. MD§; Schadde, Eric MD*; Müllhaupt, Beat MD; Clavien, Pierre-Alain MD, PhD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e318272dea2
Original Articles From the ESA Proceedings
Abstract

Objective: To integrate the amount of hepatic steatosis in modern liver allocation models.

Background: The aim of this study was to combine the 2 largest liver transplant databases (United States and Europe) in 1 comprehensive model to predict outcome after liver transplantation, with a novel focus on the impact of the presence of steatosis in the graft.

Methods: We adjusted the balance of risk (BAR) score for its application to the European Liver Transplant Registry (ELTR) database containing 11,942 patients. All liver transplants from ELTR and United Network for Organ Sharing with recorded liver biopsies were then combined in one survival analysis in relation to the presence of graft micro- (n = 9,677) and macrosteatosis (n = 11,516).

Results: Microsteatosis, regardless of the amount, was associated with a similar relationship between mortality and BAR score as nonsteatotic livers. Low-grade macrosteatotic liver grafts (≤30% macrosteatosis) resulted in 5-year graft-survival rates of 60% or more up to BAR 18, comparable to nonsteatotic grafts. However, use of moderate or severely steatotic liver grafts (>30% macrosteatosis) resulted in acceptable outcome only if the cumulative risk at transplant was low, that is, BAR score of 9 or less.

Conclusions: Microsteatotic or 30% or less macrosteatotic liver grafts can be used safely up to BAR score of 18 or less, but liver grafts with more than 30% macrosteatotis should be used with risk adjustment, that is, up to BAR score of 9 or less.

In Brief

Using both US and European databases, we show that microsteatotic or 30% or less macrosteatotic liver grafts can be used safely up to a BAR (balance of risk) score of 18 or less, but liver grafts with more than 30% macrosteatosis should be used with risk adjustment, that is, up to a BAR score of 9 or less.

Author Information

*Swiss HPB and Transplant Center, Department of Surgery, University Hospital Zurich, Switzerland

Department of Gastroenterology and Hepatology, University Hospital Zürich, Switzerland

Hepato Biliary Center, Paul Brousse Hospital, Villejuif, Paris South University; and European Liver Transplant Registry (ELTR)

§The Royal Free Sheila Sherlock Liver Centre, The Royal Free Hospital, London; University College London (UCL); and European Liver and Intestine Transplant Association (ELITA), Birmingham, United Kingdom.

Reprints: Pierre-Alain Clavien, MD, PhD, Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail: clavien@access.uzh.ch.

The authors P.D. and A.S. contributed equally.

This work was supported by a grant from the Liver and Gastrointestinal Disease (LGID) Foundation.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.