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Assessment of hepatic steatosis by transplant surgeon and expert pathologist: A prospective, double-blind evaluation of 201 donor livers
Article first published online: 17 MAR 2013
Copyright © 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 4, pages 437–449, April 2013
How to Cite
Yersiz, H., Lee, C., Kaldas, F. M., Hong, J. C., Rana, A., Schnickel, G. T., Wertheim, J. A., Zarrinpar, A., Agopian, V. G., Gornbein, J., Naini, B. V., Lassman, C. R., Busuttil, R. W. and Petrowsky, H. (2013), Assessment of hepatic steatosis by transplant surgeon and expert pathologist: A prospective, double-blind evaluation of 201 donor livers. Liver Transpl, 19: 437–449. doi: 10.1002/lt.23615
This study was supported by a University of California Los Angeles Senate Faculty Grant and the Pfleger Liver Foundation (to Henrik Petrowsky).
- Issue published online: 27 MAR 2013
- Article first published online: 17 MAR 2013
- Accepted manuscript online: 13 FEB 2013 12:50PM EST
- Manuscript Accepted: 23 DEC 2012
- Manuscript Received: 31 AUG 2012
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. Liver Transpl 19:437–449, 2013. © 2013 AASLD.