Liver transplantation (LT) is the only definitive treatment for end-stage liver disease, yet the UK has seen a 400% increase in liver disease-related deaths since 1970, constrained further by a critical shortage of donor organs. This shortfall has necessitated the use of extended criteria donor organs, including those with evidence of steatosis. The impact of hepatic steatosis (HS) on graft viability remains a concern, particularly for donor livers with moderate to severe steatosis which are highly sensitive to the process of ischaemia-reperfusion injury (IRI) and static cold storage (SCS) leading to poor post-transplantation outcomes. This review explores the pathophysiological predisposition of steatotic livers to IRI, the limitations of SCS, and alternative preservation strategies, including novel organ preservation solutions (OPS) and normothermic machine perfusion (NMP), to mitigate IRI and improve outcomes for steatotic donor livers. By addressing these challenges, the liver transplant community can enhance the utilisation of steatotic donor livers which is crucial in the context of the global obesity crisis and the growing need to expand the donor pool.
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http://dx.doi.org/10.3390/ijms25094648 | DOI Listing |
Exp Clin Transplant
December 2024
>From the Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Vall d'Hebron Hospital, Barcelona, Spain.
Marginal liver grafts, such as those from cardiac death donors and donors with steatotic organs, are highly vulnerable to ischemia-reperfusion injury. In addition, ex situ graft alteration, either by reduction or splitting, will prolong the static cold storage time and amplify the ischemia-reperfusion injury. Hypothermic oxygenated machine perfusion has the potential to end the oxygen deprivation during preservation and accordingly improve outcomes in some marginal grafts that have been traditionally discarded.
View Article and Find Full Text PDFBMJ Open
January 2025
Amsterdam UMC Locatie AMC, Amsterdam, Netherlands.
Background: The spectrum of metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent, affecting 30% of the world's population, with a significant risk of hepatic and cardiometabolic complications. Different stages of MASLD are accompanied by distinct gut microbial profiles, and several microbial components have been implicated in MASLD pathophysiology. Indeed, earlier studies demonstrated that hepatic necroinflammation was reduced in individuals with MASLD after allogenic faecal microbiota transplantation (FMT) from healthy donors on a vegan diet.
View Article and Find Full Text PDFIntroduction: Although studies have suggested that metabolic risk profiles are prognostic factors in kidney transplantation recipients (KTRs), the prognostic value of fatty liver, a known surrogate of metabolic risk, in KTRs remain to be elucidated. The objective of this study was to investigate the association between non-invasive liver biomarkers used to assess hepatic steatotic and fibrotic burdens and graft outcomes in KTRs.
Methods: A total of 3,092 patients who underwent deceased or living donor kidney transplantation (KT) between January 2000 and December 2022 were enrolled.
Transpl Int
December 2024
Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany.
The scarcity of donors has prompted the growing utilization of steatotic livers, which are susceptible to injuries following orthotopic liver transplantation (OLT). This study aims to assess the efficacy of multidrug donor preconditioning (MDDP) in alleviating injuries of steatotic grafts following rat OLT. Lean rats were subjected to a Western-style diet with high-fat (HF) and high-fructose (HFr) for 30 days to induce steatosis.
View Article and Find Full Text PDFStem Cell Res Ther
December 2024
Laboratory of Neurobiology, Centro de Investigación Príncipe Felipe, Eduardo Primo Yúfera, 3, 46012, Valencia, Spain.
Background: Patients with steatotic liver disease may show mild cognitive impairment. Rats with mild liver damage reproduce this cognitive impairment, which is mediated by neuroinflammation that alters glutamate neurotransmission in the hippocampus. Treatment with extracellular vesicles (EV) from mesenchymal stem cells (MSC) reduces neuroinflammation and improves cognitive impairment in different animal models of neurological diseases.
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