Elevated alanine aminotransferase (ALT) in the deceased donor: impact on early post-transplant liver allograft function.

BACKGROUND & AIMS: Serum alanine aminotransferase (ALT) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1-year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. METHODS: The on-site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001­2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0­499 µ/L; moderate elevation, 500­999 µ/L (>10× upper limit of normal) and severe elevation, ≥1000 µ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1-year graft and patient survival. RESULTS: Distribution of subjects included: normal/mild, 1259 (93%); moderate, 34 (3%) and severe, 55 (4%). Risk of 30-day graft loss for the three study groups was: 72 (6%), 3 (9%) and 3 (6%) (P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87%), 1048 (88%); moderate, 31 (91%), 31 (91%) and severe, 43 (88%), 44 (90%) (P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end-stage liver disease score (MELD) demonstrates no statistically significant difference among the three study groups. CONCLUSIONS: This study demonstrates clinical equivalence in early graft function and 1-year graft and patient survival for donor livers with varying peak levels of serum ALT. These donor allografts may, therefore, be utilized successfully.

Rapid Decrease in Liver Graft Steatosis in the Early Post-transplant Period: A Blinded and Randomized Study.

AIMS: Previous research suggests a rapid post-transplant decrease in liver steatosis. With increased use of liver grafts with steatosis, better understanding of this post-transplant change will facilitate successful liver transplantation. This study compares liver reperfusion biopsies with early post-transplant surveillance biopsies to evaluate and quantitate change in steatosis. METHODS: All liver grafts with ≥ 10% steatosis were extracted for analysis. Allograft biopsies on day 0 and day 3 post-transplant were randomly read, in a blinded fashion, by a single, experienced liver pathologist. Ten non-steatotic grafts were interspersed as controls. Slides were scored for macro-, micro-, and total steatosis. RESULTS: Overall, 151 subjects with steatosis were available for study. A decrease in steatosis was seen for most grafts: microvesicular (69%), macrovesicular (64%), and total steatosis (77%). There was a greater decrease in steatosis for grafts with high baseline steatosis (> 40% baseline steatosis with -30% reduction; 20%-39% baseline steatosis with -15% reduction; and < 20% baseline steatosis with -5% reduction). CONCLUSIONS: These results confirm a marked post-transplant decrease in steatosis that occurs within 3 to 5 days for most liver grafts with steatosis. These findings support the continued use of liver grafts with steatosis as this pathology appears to resolve quickly after transplant.

Radiologic Assessment of Muscle and Fat Stores in Long-Term Type I Diabetics Referred for Pancreas Transplant Compared to Healthy Controls.

Type 1 diabetes (DM1) is associated with loss of skeletal muscle and bone mass and may affect body fat stores. This study employs computed tomography (CT) scans to assess the body composition of DM1 patients referred for pancreas transplant compared to healthy controls. A 1:1 case-control design matched study patients with otherwise healthy patients from the trauma database. Matching criteria included age ± 5 years, gender, and body mass index (BMI) ± 2kg/m2. Nutrition variables included serum albumin and protein levels, BMI, and CT measures of muscle mass and fat stores. There were 22 subjects and 22 controls (median DM1 duration 24 years). DM1 patients had less muscle mass and less subcutaneous fat but no difference in visceral fat. Patients with the greatest muscle deficit were those with DM1 greater than 20 years and those younger than age 40. DM1 patients maintain similar BMI and protein levels compared to healthy controls but have marked deficits of muscle and subcutaneous fat. These results inform the nutritional management of DM1 patients and quantify the muscle and fat deficits present in these patients. At highest risk are young patients and those with duration of DM1 over 20 years.