O91: The Negative Impact of Transplant Liver Steatosis is Significantly Exaggerated in Donation Following Circulatory Death: A National Cohort Study

Abstract Introduction The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, perhaps related to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate whether the impact of steatosis differs in grafts donated following brainstem (DBD) versus circulatory death (DCD). Methods The NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data, and adjusted regression models with interaction terms to compare the impact of donor graft steatosis (visually-assessed) on transplant outcome in DCD versus DBD. Results 9217 adult recipients of deceased donor grafts were included (DBD=7349; DCD=1868). Multivariable cox regression revealed that the negative effects of moderate or severe steatosis on graft survival were significantly different in DCD and DBD livers (interaction P=0.011 and P=0.043). The largest impact was in DCD livers (aHR=1.851, 1.296-2.645, P=0.001 for moderate and aHR=5.426, 1.723-17.090, P=0.004 for severe steatosis). In contrast, steatotic livers did not suffer inferior longer-term graft survival in the DBD cohort, despite inferior early outcomes. Conclusion The impact of steatosis on transplant outcome differs significantly based on donor type, with a much larger negative impact in DCD, proving that steatotic livers are specifically sensitive to the DCD process. This highlights a high-risk group which should be the target of novel therapeutics to allow this growing sector of the donor pool to be safely utilised. In contrast, moderate-severe steatosis does not impact longer term outcome in DBDs, and such grafts can be transplanted with excellent outcome.