Clinical implications of preoperative and intraoperative liver biopsies for evaluating donor steatosis in living related liver transplantation

Abstract

The role of liver biopsy in selecting optimal donors is an area of continuing controversy in living donor liver transplantation (LDLT). Our aim was to assess the potential implications of preoperative and intraoperative biopsies for evaluating donor liver fat content. Three thousand eight hundred fifty-nine consecutive subjects underwent predonation needle biopsy of the right lobe, and 1766 of these subjects actually donated their livers for LDLT and underwent intraoperative wedge biopsies of paired right and left lobes. The preoperative workup protocol also included abdominal ultrasonography (USG) and computed tomography (CT). Intersample agreement on steatosis grades (<5%, 5% to <15%, 15% to <30%, and 30%) was calculated, and clinicometabolic factors related to sampling variability were evaluated. For detecting 30% steatosis in the 3859 potential donors, USG and CT had sensitivities of 84.9% and 57.3%, specificities of 76.3% and 92.7%, positive predictive values of 29.6% and 48.0%, and negative predictive values of 97.7% and 94.8%, respectively. Analyses of the 1766 actual donors showed that with respect to the total steatosis grades of intraoperative right and left biopsies versus preoperative biopsy, 36.7% and 36.0% of the pairs, respectively, differed from the weighted j values of 0.44 and 0.40. Similar agreement levels existed for macrovesicular and microvesicular steatosis subtypes. The per-subject agreement rate for the total steatosis grade between intraoperative right and left biopsies was 83.6%. According to a multivariate analysis, independent factors affecting the variability of the total steatosis results from preoperative and intraoperative biopsies (major features) were higher systolic blood pressure, body mass index, and alanine aminotransferase values and lower high-density lipoprotein cholesterol values. In conclusion, imaging may be insufficiently sensitive for evaluating donor hepatic steatosis. Preoperative and selective intraoperative liver biopsies are mandatory for assessing donor steatosis in LDLT unless preoperative imaging demonstrates no fat. Liver Transpl 20:437-445, 2014. V C 2014 AASLD.

Intimate association of visceral obesity with non‐alcoholic fatty liver disease in healthy Asians: A case‐control study

“…If we also consider our results, there seems to be accumulating evidence that even healthy, non‐obese subjects could be candidates for NAFLD screening and monitoring in the future, particularly if they have a certain risk factor such as high visceral adiposity. If our findings are borne out in further studies including cost‐effectiveness analysis, adding a single‐slice unenhanced CT scan to routine health‐check programs for dyslipidemic patients may be of potential benefit, given the suboptimal performance of ultrasonographic study, even in detecting cases of severe fat infiltration of liver . This concept was previously supported by van der Poorten et al ., who reported that visceral fat was directly associated with NASH and fibrosis in NAFLD patients .…”

NAFLD and liver transplantation: Current burden and expected challenges

“…Some centers perform routine liver biopsy for all potential donors, while other centres only perform liver biopsy in selected high risk donors (older age, comorbidities, abnormal liver function tests). Assessment of steatosis through visual inspection of the graft has a positive predictive value of less than 20% for mild steatosis and only 70% for severe steatosis [58]. Surrogate markers of steatosis, like liver ultrasound coexisting with normal transaminases have also been proposed.…”

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

“…Previously in our center, liver quality was assessed based on liver biopsy which was performed when moderate or severe fatty change was suspected in sonography or CT image and donors with <30% macrovesicular steatosis were accepted. However, since 2010, MRS and/or MR chemical shifting technique (especially in cases with heterogenous fatty distribution) has been routinely performed to evaluate the degree of fatty change with its good correlation . At present, we cautiously accept donors considering other factors together if fat fraction was >10%.…”