Assessment of donor steatosis in liver transplantation: is it possible without liver biopsy?
BACKGROUND
Macrovesicular steatosis of the liver is associated with early dysfunction or poor function of the graft after transplantation; however, it can be quantified accurately only through a liver biopsy that sometimes may not be available and whose result is anyway known when the recipient has already been selected. It would, therefore, be helpful to be able to predict the degree of steatosis, on the basis of non-invasive readily available variables.


METHODS
Data from 374 deceased liver donors from whom a liver biopsy had been taken were analyzed with the receiver operating characteristic area [area under the curve (AUC)] to identify variables that could predict the degree of macrovesicular steatosis classified as: absent to mild (0-30%) and moderate to severe (>30%).


RESULTS
Steatosis was associated significantly with donor age, increased body mass index (BMI), presence of type II diabetes, ultrasonographic features, heavy alcohol consumption, transaminases [aspartate-aminotransferase and alanine-aminotransferase (ALT)], gamma-glutamyl-transpeptidase, and glucose blood levels. The combination of BMI, elevation of ALT, presence of type II diabetes, history of heavy alcohol consumption, and ultrasonography signs of steatosis could identify steatosis >30% accurately with an AUC of 0.86 (95% CI = 0.81-0.91).


CONCLUSIONS
Fatty infiltration in liver donors can be estimated based on clinical and biochemical parameters.
Cucchetti
Alessandro
A
Liver and Multiorgan Transplant Unit, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Vivarelli
Marco
M
Ravaioli
Matteo
M
Cescon
Matteo
M
Ercolani
Giorgio
G
Piscaglia
Fabio
F
Del Gaudio
Massimo
M
Grazi
Gian Luca
GL
Ridolfi
Lorenza
L
Pinna
Antonio Daniele
AD
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000437:Alcoholism / Q000150:complications; D001707:Biopsy, Needle; D002102:Cadaver; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography
D000410:Alanine Transaminase