Steatotic Graft for Liver Transplantation

Lee, Kyung Keun; Chu, Chong Woo; Chung, Jun Chul; Kim, Hyung Chul

Abstract

It is common practice to reject potential grafts with fatty change over 30%. We report a case of successful liver transplant using a graft with 70% fatty liver. The patient was a 53 year old male with alcoholic liver cirrhosis who had received endoscopic varix ligation (EVL) for esophageal varix bleeding 4 months ago. He presented with esophageal varix bleeding and drowsy mentality, and was admitted to the ICU via the emergency room. He received EVL again. Preoperative total bilirubin was 11.4 mg/dl, prothrombin time was 40%. The donor was a 50 year old male with diabetes. Liver biopsy showed 70% fatty liver. The operation took 10 hours, and there was no intraoperative complication. Sixteen days after the operation, liver enzymes were normal but total bilirubin was elevated up to 10.26 mg/dl. Liver biopsy was done. Biopsy showed almost no fatty liver but it showed moderate rejection, so steroid recycling was done. Total bilirubin decreased steadily. But 38 days after the operation, ascites increased, and follow-up liver biopsy again showed almost no fatty change but showed severe rejection. Steroid pulse therapy was done, and after pulse therapy the amount of ascites decreased, and the patient was discharged 56 days after the transplantation in tolerable condition. Brain death donor liver grafts with severe fatty liver increase the risk of post transplant complications such as renal failure. But since severe fatty liver does not always cause primary nonfunction, it may be considered as transplant grafts in selected cases.