Pretransplant assessment of human liver grafts by plasma lecithin: cholesterol acyltransferase (LC AT) activity in multiple organ donors

Abstract. In spite of the improved outcome of orthotopic liver transplantation (OLTx), primary graft nonfunction remains one of the life‐threatening problems following OLTx. The purpose of this study was to evaluate plasma lecithin: cholesterol acyltransferase (LCAT) activity in multiple organ donors as a predictor of liver allograft viability prior to OLTx. Thirty‐nine donors were studied during a 5‐month period between April and August 1988. Allograft hepatectomy was performed using a rapid technique or its minor modification with hilar dissections, and the allografts were stored cold (4°C) in University of Wisconsin (UW) solution. Early post‐transplant allograft function was classified as good, fair, or poor, according to the highest SGOT, SGPT, and prothrombin time within 5 days following OLTx. Procurement records were reviewed to identify donor data, which included conventional liver function tests, duration of hospital stay, history of cardiac arrest, and graft ischemic time. Blood samples from the donors were drawn immediately prior to aortic crossclamp, and from these plasma LCAT activity was determined. Plasma LCAT activity of all donors was significantly lower than that of healthy controls (12.4 ±8.0 vs 39.2 ± 13.3 μg/ml per hour, P < 0.01). LCAT activity (16.4 ± 8.3 μg/ml per hour) in donors of grafts with good function was significantly higher than that in those with fair (8.6 ± 4.5 μg/ml per hour, P < 0.01) or poor (7.3 ± 2.4 μg/ml per hour, P < 0.01) function. Information regarding procurement, which was complete in the records of 31 of 39 donors, was used in a multiple logistic regression analysis that revealed plasma LCAT activity to be the only factor able to discriminate the quality of the hepatic graft from other variables in multiple organ donors. The present study suggests that the determination of plasma LCAT activity in multiple organ donors is extremely useful for the assessment of hepatic allograft viability prior to OLTx.