Fatal diffuse pulmonary fat microemboli following reperfusion in liver transplantation with the use of marginal steatotic allografts

David M Rosenfeld, Maxwell L. Smith, David P. Seamans, Emmanouil Giorgakis, Brantley D. Gaitan, Narjeet Khurmi, Bashar A. Aqel, Kunam S. Reddy

Research output: Contribution to journalArticle

Abstract

Organ shortage is a major cause of delayed liver transplantation and increased waitlist time. The level of donor steatosis is a significant determinant in organ selection. Scarcity of organs has led some programs to expand their acceptable criteria for the percentage of steatosis. We report two cases of liver transplantation of steatotic donor organs that resulted in mortality within hours from transplantation. Postmortem analysis showed evidence of diffuse pulmonary fat microemboli likely originating from the donor organ, with marked preservation reperfusion injury. The mechanism of diffuse fat microemboli in this setting and possible relationship to other perioperative syndromes (transfusion-related lung injury, acute kidney injury, and postreperfusion syndrome) is discussed.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StatePublished - Jan 1 2019

Keywords

  • anesthesia/pain management
  • donors and donation: extended criteria
  • ischemia reperfusion injury (IRI)
  • liver allograft function/dysfunction
  • liver transplantation/hepatology
  • pathology/histopathology
  • risk assessment/risk stratification
  • transfusion

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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