Assessment of donor steatosis in liver transplantation: is it possible without liver biopsy?
Article first published online: 17 APR 2009
© 2009 John Wiley & Sons A/S
Volume 23, Issue 4, pages 519–524, August/September 2009
How to Cite
Cucchetti, A., Vivarelli, M., Ravaioli, M., Cescon, M., Ercolani, G., Piscaglia, F., Gaudio, M. D., Grazi, G. L., Ridolfi, L. and Pinna, A. D. (2009), Assessment of donor steatosis in liver transplantation: is it possible without liver biopsy?. Clinical Transplantation, 23: 519–524. doi: 10.1111/j.1399-0012.2009.00987.x
- Issue published online: 28 JUL 2009
- Article first published online: 17 APR 2009
- Accepted for publication 20 March 2009
- graft injury;
- liver donor;
- liver steatosis;
- liver transplantation;
- organ procurement
Abstract: Background: Macrovesicular steatosis of the liver is associated with early dysfunction or poor function of the graft after transplantation; however, it can be quantified accurately only through a liver biopsy that sometimes may not be available and whose result is anyway known when the recipient has already been selected. It would, therefore, be helpful to be able to predict the degree of steatosis, on the basis of non-invasive readily available variables.
Methods: Data from 374 deceased liver donors from whom a liver biopsy had been taken were analyzed with the receiver operating characteristic area [area under the curve (AUC)] to identify variables that could predict the degree of macrovesicular steatosis classified as: absent to mild (0–30%) and moderate to severe (>30%).
Results: Steatosis was associated significantly with donor age, increased body mass index (BMI), presence of type II diabetes, ultrasonographic features, heavy alcohol consumption, transaminases [aspartate-aminotransferase and alanine-aminotransferase (ALT)], gamma-glutamyl-transpeptidase, and glucose blood levels. The combination of BMI, elevation of ALT, presence of type II diabetes, history of heavy alcohol consumption, and ultrasonography signs of steatosis could identify steatosis >30% accurately with an AUC of 0.86 (95% CI = 0.81–0.91).
Conclusion: Fatty infiltration in liver donors can be estimated based on clinical and biochemical parameters.