title: How to Perform Selective Liver Biopsy in Living Liver Donors Using Plain Computed Tomography.
abstract: BACKGROUND
  Preoperative donor liver biopsy is the criterion standard to verify the quality of a liver. However, it can cause some complications, thus this study was designed to know whether selective liver biopsy is possible or not, and to find a subgroup that does not require preoperative biopsy.
  
  
  METHODS
  We reviewed preoperative images and postoperative outcome in 118 donors from September 2013 to January 2014. Visual grading of steatosis on plain computed tomography (CT) was performed and compared steatosis on preoperative liver biopsy was done within 7 days from the CT scan.
  
  
  RESULTS
  Visual grades of plain CT were 1 (n = 50, 42.4%), 2 (n = 47, 39.8%), 3 (n = 13, 11.0%), 4 (n = 7, 5.9%), and 1 (n = 1, 0.8%). Macrovesicular steatosis on liver biopsy according to visual grades were 1 (0.67 ± 1.3%), 2 (1.67 ± 1.8%), 3 (6.23 ± 6.4%), 4 (14.7 ± 16.6), and 5 (30%). Right liver grafts including right lobe, modified right lobe, and extended right lobe were procured in 106 (89.9%) donors, and 16% (17/106) of the donors were visual grades 3, 4, and 5. Eleven donors (64.7%) were accepted for right liver donation after liver biopsy, whereas 6 (35.3%) donors were deemed possible to donate right liver after weight reduction and reevaluation of steatosis. Transient hepatic dysfunction after right hepatectomy was significantly increased according to the increment of visual grade.
  
  
  CONCLUSIONS
  Preoperative liver biopsy may not be necessary in visual grade 1 or 2 donors, but should be performed for grade 3 and 4 donors based on recipient's urgency so as to decide whether to proceed with right hepatectomy or not.
authors: 1 Hana Academy Seoul, Seoul, Korea. 2 Department of Surgery, College of Medicine Inje University, Busan Paik Hospital, Busan, Korea. 3 Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Sun-Kyeong
authors: SK
authors: Moon
authors: Yo-Han
authors: YH
authors: Park
authors: Deok-Bog
authors: DB
authors: Moon
authors: Shin
authors: S
authors: Hwang
authors: Chul-Soo
authors: CS
authors: Ahn
authors: Ki-Hun
authors: KH
authors: Kim
authors: Tae-Yong
authors: TY
authors: Ha
authors: Gi-Won
authors: GW
authors: Song
authors: Dong-Hwan
authors: DH
authors: Jung
authors: Gil-Chun
authors: GC
authors: Park
authors: Sung-Gyu
authors: SG
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000379:methods*; D005234:Fatty Liver / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*