title: Effects of donor steatosis on liver biochemistry and significance of body mass index in predicting steatosis.
abstract: BACKGROUND
  Hepatic steatosis is a major concern in living donor liver transplantation. Factors affecting hepatic functional status after a donor right hepatectomy (with the middle hepatic vein included in the graft) with a focus on changes owing to steatosis were retrospectively studied.
  
  
  METHODS
  Donors (n = 325) were categorized into three groups: G0 (no steatosis, n = 178), G1 (< = 10% steatosis, n = 128) and G2 (>10% steatosis, n = 19). Donors with >20% steatosis were excluded. Changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin levels and prothrombin time (PT) were assessed. Factors predicting steatosis were also assessed. A liver biopsy was performed on selected donors.
  
  
  RESULTS
  The ALT level rose until day 3 in G1 and day 6 in G2 (P < 0.05). The AST level rose until day 7 in G2 (P < 0.05) but stayed unchanged in G1. The bilirubin level was higher only on day 1 in G2 (P < 0.05). By day 30, no significant difference between any groups was noted. Receiver-operating characteristic (ROC) area under the curve for body mass index (BMI) on predicting steatosis was 0.75 [confidence interval (CI) = 69-80]. Among donors with a BMI > 23.5 kg/m(2), 75% had steatosis. Five donors had >20% steatosis and were not assessed.
  
  
  CONCLUSIONS
  Using a liver with up to 20% steatosis in right liver donation, even if the middle hepatic vein is included in the graft, is safe. For Asian donors, a BMI > 23.5 kg/m(2) is a guide in deciding whether to perform a liver biopsy for steatosis.
authors.affiliation: Department of Surgery, the University of Hong Kong, Hong Kong, China.
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Siriwardana
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002681:China; D046148:Donor Selection; D005234:Fatty Liver / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin