title: Assessment of hepatic steatosis by transplant surgeon and expert pathologist: a prospective, double-blind evaluation of 201 donor livers.
abstract: An accurate clinical assessment of hepatic steatosis before transplantation is critical for successful outcomes after liver transplantation, especially if a pathologist is not available at the time of procurement. This prospective study investigated the surgeon's accuracy in predicting hepatic steatosis and organ quality in 201 adult donor livers. A steatosis assessment by a blinded expert pathologist served as the reference gold standard. The surgeon's steatosis estimate correlated more strongly with large-droplet macrovesicular steatosis [ld-MaS; nonparametric Spearman correlation coefficient (rS ) = 0.504] versus small-droplet macrovesicular steatosis (sd-MaS; rS  = 0.398). True microvesicular steatosis was present in only 2 donors (1%). Liver texture criteria (yellowness, absence of scratch marks, and round edges) were mainly associated with ld-MaS (variance = 0.619) and were less associated with sd-MaS (variance = 0.264). The prediction of ≥30% ld-MaS versus <30% ld-MaS was excellent when liver texture criteria were used (accuracy = 86.2%), but it was less accurate when the surgeon's direct estimation of the steatosis percentage was used (accuracy = 75.5%). The surgeon's quality grading correlated with the degree of ld-MaS and the surgeon's steatosis estimate as well as the incidence of poor initial function and primary nonfunction. In conclusion, the precise estimation of steatosis remains challenging even in experienced hands. Liver texture characteristics are more helpful in identifying macrosteatotic organs than the surgeon's actual perception of steatosis. These findings are especially important when histological assessment is not available at the donor's hospital.
authors: Department of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-7054, USA.
authors: Hasan
authors: H
authors: Yersiz
authors: Coney
authors: C
authors: Lee
authors: Fady M
authors: FM
authors: Kaldas
authors: Johnny C
authors: JC
authors: Hong
authors: Abbas
authors: A
authors: Rana
authors: Gabriel T
authors: GT
authors: Schnickel
authors: Jason A
authors: JA
authors: Wertheim
authors: Ali
authors: A
authors: Zarrinpar
authors: Vatche G
authors: VG
authors: Agopian
authors: Jeffrey
authors: J
authors: Gornbein
authors: Bita V
authors: BV
authors: Naini
authors: Charles R
authors: CR
authors: Lassman
authors: Ronald W
authors: RW
authors: Busuttil
authors: Henrik
authors: H
authors: Petrowsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D003661:Decision Support Techniques; D046148:Donor Selection; D004311:Double-Blind Method; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D010340:Pathology, Surgical / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014019:Tissue Donors; D055815:Young Adult