Noninvasive estimation of hepatic steatosis in living liver donors: usefulness of visceral fat area measurement.
BACKGROUND
Hepatic steatosis in the donor liver is associated with an increased risk of complications after liver transplantation. Mandatory liver biopsy for all potential donors, however, remains controversial. To define clinico-pathological correlation, we reviewed our criteria for liver biopsy and examined the use of visceral fat area (VFA) estimation by computed tomography image.


METHODS
Our criteria for biopsy are as follows: an aspartate aminotransferase/alanine aminotransferase ratio of less than 1, a body mass index more than or equal to 25 kg/m2, and a suspected fatty liver on ultrasonography. Dietary intervention is indicated for overweight donor candidates and for those with more than 10% hepatic steatosis. Clinical data of consecutive 78 potential donors who underwent percutaneous liver biopsy (biopsy group) and 70 donors whose biopsy were omitted (control group) were reviewed.


RESULTS
Donors in biopsy group were male dominant with a median age of 35 (20-63) years. Hepatic steatosis more than or equal to 10% was seen in nine of 78 donors; older age (P=0.012), ultrasonographic findings (P=0.002), VFA (P=0.008), and percent VFA (VFA/[VFA+subcutaneous fat area]; P=0.009) were associated with more than 10% hepatic steatosis. The area under the receiver operating characteristics curve of VFA and percent VFA for detecting hepatic steatosis more than or equal to 10% were 0.803 and 0.778, respectively. Hepatic steatosis was successfully reduced to less than 10% through dietary intervention in six of the nine donor candidates.


CONCLUSIONS
Our current biopsy criteria are acceptable to select donor candidates at risk for hepatic steatosis. Visceral fat measurement can be used as an additional factor to narrow donors at risk and to monitor visceral fat reduction during dietary intervention.
Yamashiki
Noriyo
N
Organ Transplantation Service, University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
Sugawara
Yasuhiko
Y
Tamura
Sumihito
S
Kaneko
Junichi
J
Matsui
Yuichi
Y
Togashi
Junichi
J
Ohki
Takamasa
T
Yoshida
Haruhiko
H
Omata
Masao
M
Makuuchi
Masatoshi
M
Kokudo
Norihiro
N
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001707:Biopsy, Needle; D005234:Fatty Liver / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000178:diet therapy; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000473:pathology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D014463:Ultrasonography; D055815:Young Adult
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase