Assessment of hepatic steatosis by transplant surgeon and expert pathologist: A prospective, double-blind evaluation of 201 donor livers

Authors

  • Hasan Yersiz,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Coney Lee,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Fady M. Kaldas,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Johnny C. Hong,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Abbas Rana,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Gabriel T. Schnickel,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Jason A. Wertheim,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Ali Zarrinpar,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Vatche G. Agopian,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Jeffrey Gornbein,

    1. Biomathematics, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Bita V. Naini,

    1. Pathology, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Charles R. Lassman,

    1. Pathology, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Ronald W. Busuttil,

    1. Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • Henrik Petrowsky

    Corresponding author
    • Departments of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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  • See Editorial on Page 360

  • This study was supported by a University of California Los Angeles Senate Faculty Grant and the Pfleger Liver Foundation (to Henrik Petrowsky).

Address reprint requests to Henrik Petrowsky, M.D., Department of Surgery, Dumont-UCLA Transplant Center, Ronald Reagan-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, 650 CE Young Drive South, 77-120 CHS, Los Angeles, CA 90095-7054. E-mail: henrik.petrowsky@usz.ch

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. Liver Transpl 19:437–449, 2013. © 2013 AASLD.

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