Liver biopsy findings from healthy potential living liver donors: reasons for disqualification, silent diseases and correlation with liver injury tests.
OBJECTIVE
Liver biopsies detect silent donor disease in potential living liver donors and provide material for studies of subclinical non-alcoholic fatty liver disease (NAFLD). Our primary goal was to determine the contribution of biopsy findings to potential donor evaluation. Factors contributing to pre-clinical NAFLD and correlations between liver injury tests and histopathology have been also determined.


METHODS
Patient records, laboratory tests and results of the histopathologic examination and diagnoses of 284 patients from 2001 to 2005 were retrospectively extracted from the EDIT database. Hepatic histology was correlated with liver injury tests and with general demographic characteristics in an otherwise normal healthy population.


RESULTS
A minority (n=119; 42%) of biopsies from this population of 143 males/141 females (average age=36.8years; mean BMI=26.6) were completely normal. The remainder showed steatosis (n=107; 37%), steatohepatitis (n=44; 15%), or unexplained low-grade/early stage chronic hepatitis, primary biliary cirrhosis, or nodular regenerative hyperplasia (n=16; 6%). Biopsy findings disqualified 29/56 donors. Independent risk factors for NAFLD by multivariate modeling, which differed by sex, included: BMI (p=0.0001), age (p=0.003), iron (p=0.01), and ALT (p=0.004).


CONCLUSIONS
Liver biopsies provide valuable information about otherwise undetectable liver disease in potential liver donors. Obesity, age and iron, which are influenced by sex, contribute to NAFLD pathogenesis. Blood tests other than standard liver profiles are needed to detect early NAFLD.
Minervini
Marta I
MI
Department of Pathology, University of Pittsburgh Medical Center-ISMETT, Italy. mminervini@ISMETT.edu
Ruppert
Kristine
K
Fontes
Paulo
P
Volpes
Riccardo
R
Vizzini
Giovanni
G
de Vera
Michael E
ME
Gruttadauria
Salvatore
S
Miraglia
Roberto
R
Pipitone
Loredana
L
Marsh
J Wallis
JW
Marcos
Amadeo
A
Gridelli
Bruno
B
Demetris
Anthony J
AJ
D000328:Adult; D001706:Biopsy / Q000379:methods; D015992:Body Mass Index; D005006:Ethnicity; D005234:Fatty Liver / Q000453:epidemiology; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries* / Q000473:pathology*; D008107:Liver Diseases / Q000453:epidemiology*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D044469:Racial Groups; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors