title: Noninvasive evaluation of graft steatosis in living donor liver transplantation.
abstract: BACKGROUND
  Hepatic steatosis affects graft function as well as postoperative recovery of donors in living donor liver transplantation. Liver macrovesicular steatosis in living donors was assessed using quantitative X-ray computed tomography (CT) analysis and histological examination of intraoperative liver biopsy.
  
  
  METHODS
  A total of 266 living donors with complete pretransplant CT data and intraoperative "time 0" biopsy were included in the study. Liver biopsy specimen obtained during donor operation was examined for macrovesicular steatosis and was classified as none; mild (<30%); moderate (30%-60%); or severe (>60%). Liver-to-spleen CT attenuation values ratio (L/S ratio) on noncontrast-CT was evaluated for its usefulness as an index of hepatic steatosis in comparison with other parameters including body mass index (BMI) and serum liver function tests (gamma-glutamyl transpeptidase, alanine aminotransferase, aspartate aminotransferase, cholinesterase, and total cholesterol) using receiver operating characteristic (ROC) analysis. RESULTS.: Histological grade of macrovesicular steatosis was none in 198 patients (74.4%), mild in 50 (18.8%), moderate in 15 (5.7%), and severe in 3 (1.1%). The median L/S ratios for the respective histological grades were 1.20 (range: 1.00-1.46), 1.12 (0.83-1.37), 1.01 (0.74-1.21), and 0.90 (0.70-0.99) (P<0.0001). The ROC curve for L/S ratio was located closest to the upper left corner, and the area under the curve of L/S ratio was significantly larger than that of any other preoperative variables.
  
  
  CONCLUSIONS
  L/S ratio calculated from preoperative CT can be a useful tool to discriminate hepatic macrovesicular steatosis. Based on the present results, the optimal cut-off value for L/S ratio to exclude more than moderate steatosis would be 1.1.
authors.affiliation: Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. iwasaki@kuhp.kyoto-u.ac.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Sachiko
authors.initials: S
authors.lastname: Minamiguchi
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Yoji
authors.initials: Y
authors.lastname: Maetani
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Fujii
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000473:pathology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000473:pathology; D012372:ROC Curve; D012189:Retrospective Studies