Macrovesicular Steatosis(MS)is an independent risk factor for adverse post-liver transplant(LT)outcomes.The degree of MS is intimately related to the viability of the liver graft,which in turn is crucial to the succes...Macrovesicular Steatosis(MS)is an independent risk factor for adverse post-liver transplant(LT)outcomes.The degree of MS is intimately related to the viability of the liver graft,which in turn is crucial to the success of the operation.An ideal liver graft should have no MS and most centres would find it unacceptable to use a donor liver with severe MS for LT.While a formal liver biopsy is the goldstandard diagnostic test for MS,given the logistical and time constraints it is not universally feasible.Other tests like a frozen section biopsy are plagued by issues of fallibility with reporting and sampling bias making them inferior to a liver biopsy.Hence,the development of an accurate,non-invasive,easy-to-use,handheld,real-time device for quantification of MS would fill this lacuna in the deceased donor selection process.We present the hypothesis,design and proof-ofconcept of a study,which aims to standardise and determine the feasibility and accuracy of a novel handheld device applying the principle of diffuse reflectance spectroscopy for real-time quantification of MS.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)has emerged as a silent epidemic having substantial clinical implications,with liver transplantation being one of the areas most impacted.The increasing p...Metabolic dysfunction-associated steatotic liver disease(MASLD)has emerged as a silent epidemic having substantial clinical implications,with liver transplantation being one of the areas most impacted.The increasing prevalence of metabolic fatty liver disease has reduced the quality of available donor organs.While noninvasive methods are increasingly applied to evaluate liver steatosis in deceased donors,liver biopsy remains the gold standard.Many aspects of liver biopsies are not yet fully standardized.Macrovesicular hepatic steatosis is associated with decreased allograft quality and poorer short-and long-term transplant outcomes,especially in moderate and severe steatotic cases.Donation after cardiac arrest further exacerbates these poor outcomes.Matching marginal allografts with suitable recipients based on recipient characteristics is crucial for improving transplant outcomes.Living donor liver transplant is a feasible option for addressing organ shortages.Noninvasive evaluation is preferred for assessing liver health;however,when the results are inconclusive,a liver biopsy is recommended.Lifestyle modifications can improve graft,living donor and recipient outcomes.Analysis of the impact of MASLD on the donor pool and the implementation of new optimization strategies are essential to ensure the sustainability of transplantation as a curative treatment for advanced liver cirrhosis.The aim of this review was to summarize the effect of MASLD on the liver donor population,highlighting how to evaluate steatosis in donors,and to discuss its clinical implications as well as strategies to optimize organ allocation in the MASLD era.展开更多
Since the very early days of clinical liver transplantation(LT),transplant surgeons and professionals have been confronted with the increased risk of failure associated with the use of fatty liver grafts(1).Notwithsta...Since the very early days of clinical liver transplantation(LT),transplant surgeons and professionals have been confronted with the increased risk of failure associated with the use of fatty liver grafts(1).Notwithstanding the wide variability in steatosis assessment across different centers and pathologists(2),utilization of livers with moderate(≥30%)or severe(≥60%)macrovesicular steatosis has been consistently associated with an increased risk of primary non-function,early allograft dysfunction,acute kidney injury,as well as inferior graft and patient survival(3).The mechanisms behind the increased susceptibility of steatotic livers to ischemia-reperfusion injury(IRI)are multiple,including disturbances to microcirculation due to sinusoidal narrowing,increased oxidative stress upon reperfusion and enhanced lipid peroxidation,leading to an increased release of inflammatory mediators like IL6,IL1βand so-called damage associated molecular patterns(DAMP),like cell-free DNA and mitochondrial DNA.Histologically,this is reflected by hepatocyte death by necrosis rather than apoptosis,pseudopeliotic steatosis(i.e.,the expulsion of lipid droplets into the extracellular space)and lately,by tissue remodelling and fibrosis(4,5).展开更多
文摘Macrovesicular Steatosis(MS)is an independent risk factor for adverse post-liver transplant(LT)outcomes.The degree of MS is intimately related to the viability of the liver graft,which in turn is crucial to the success of the operation.An ideal liver graft should have no MS and most centres would find it unacceptable to use a donor liver with severe MS for LT.While a formal liver biopsy is the goldstandard diagnostic test for MS,given the logistical and time constraints it is not universally feasible.Other tests like a frozen section biopsy are plagued by issues of fallibility with reporting and sampling bias making them inferior to a liver biopsy.Hence,the development of an accurate,non-invasive,easy-to-use,handheld,real-time device for quantification of MS would fill this lacuna in the deceased donor selection process.We present the hypothesis,design and proof-ofconcept of a study,which aims to standardise and determine the feasibility and accuracy of a novel handheld device applying the principle of diffuse reflectance spectroscopy for real-time quantification of MS.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)has emerged as a silent epidemic having substantial clinical implications,with liver transplantation being one of the areas most impacted.The increasing prevalence of metabolic fatty liver disease has reduced the quality of available donor organs.While noninvasive methods are increasingly applied to evaluate liver steatosis in deceased donors,liver biopsy remains the gold standard.Many aspects of liver biopsies are not yet fully standardized.Macrovesicular hepatic steatosis is associated with decreased allograft quality and poorer short-and long-term transplant outcomes,especially in moderate and severe steatotic cases.Donation after cardiac arrest further exacerbates these poor outcomes.Matching marginal allografts with suitable recipients based on recipient characteristics is crucial for improving transplant outcomes.Living donor liver transplant is a feasible option for addressing organ shortages.Noninvasive evaluation is preferred for assessing liver health;however,when the results are inconclusive,a liver biopsy is recommended.Lifestyle modifications can improve graft,living donor and recipient outcomes.Analysis of the impact of MASLD on the donor pool and the implementation of new optimization strategies are essential to ensure the sustainability of transplantation as a curative treatment for advanced liver cirrhosis.The aim of this review was to summarize the effect of MASLD on the liver donor population,highlighting how to evaluate steatosis in donors,and to discuss its clinical implications as well as strategies to optimize organ allocation in the MASLD era.
文摘Since the very early days of clinical liver transplantation(LT),transplant surgeons and professionals have been confronted with the increased risk of failure associated with the use of fatty liver grafts(1).Notwithstanding the wide variability in steatosis assessment across different centers and pathologists(2),utilization of livers with moderate(≥30%)or severe(≥60%)macrovesicular steatosis has been consistently associated with an increased risk of primary non-function,early allograft dysfunction,acute kidney injury,as well as inferior graft and patient survival(3).The mechanisms behind the increased susceptibility of steatotic livers to ischemia-reperfusion injury(IRI)are multiple,including disturbances to microcirculation due to sinusoidal narrowing,increased oxidative stress upon reperfusion and enhanced lipid peroxidation,leading to an increased release of inflammatory mediators like IL6,IL1βand so-called damage associated molecular patterns(DAMP),like cell-free DNA and mitochondrial DNA.Histologically,this is reflected by hepatocyte death by necrosis rather than apoptosis,pseudopeliotic steatosis(i.e.,the expulsion of lipid droplets into the extracellular space)and lately,by tissue remodelling and fibrosis(4,5).
