Body mass index as a predictor of hepatic steatosis in living liver donors

Abstract

Evaluation of the living donor for liver transplantation is a complex process involving such invasive studies as liver biopsy and angiography. It is important to establish the likelihood and extent of hepatic steatosis in living donors by clinical, imaging, and biochemical parameters to avoid performing a liver biopsy, if possible. In this study, the predictive value of body mass index (BMI), liver chemistry tests, and imaging studies was compared with liver histological examination in 33 potential living donors. Patients were grouped and compared based on their BMI (<25, 25 to 28, >28). No patient with a BMI less than 25 had hepatic steatosis. Of patients with a BMI of 25 to 28, steatosis was found on biopsy in 3 of 9 patients. Thirteen of 17 patients (76%) with a BMI greater than 28 had hepatic steatosis on liver biopsy. There was a significant correlation between BMI and overall grade of steatosis (R ‫؍‬ 0.49). All subjects with steatosis detected on magnetic resonance imaging (MRI) or computed tomography (CT) had steatosis on biopsy, and all but 2 such patients had greater than 10% steatosis on biopsy. Conversely, 30% of patients in the MRI group and 24% of patients in the CT group failed to show hepatic steatosis when it was present on biopsy. Thus, it appears that liver biopsy could be avoided in subjects with a normal BMI and absence of risk factors. Individuals with a high BMI should undergo liver biopsy because biochemical and imaging data are currently inadequate to determine the extent of steatosis. Future studies should aim at improving the sensitivity of imaging techniques in the diagnosis of steatosis. (Liver Transpl 2001;7:409-414.)

Visceral adiposity and insulin resistance are independent predictors of the presence of non-cirrhotic NAFLD-related portal hypertension

“…The BMI is a well-known independent predictor of fat in the liver. 40,41 Regardless of BMI, central adiposity has been shown to be associated with NAFLD in normal weight, obese and diabetic individuals. 17,42,43 As the presence of PHT is related to the degree of steatosis, and as the degree of steatosis is related to the amount of visceral fat, the predictive role of waist circumference can easily be understood.…”

Outcomes of donor evaluation in adult-to-adult living donor liver transplantation

“…Overweight and obese patients are higher-risk living liver donors because of greater likelihood of hepatic steatosis and medical problems (diabetes, hypertension, and heart disease), which could increase the postoperative complications. 12,13 However, recent data have shown that selected obese candidates may successfully undergo donation without evidence of increased complications. 14 Accepted donor candidates were more likely to be related to the recipient (including spouses) than rejected candidates.…”

Obesity and liver disease

“…In a series of 144 patients with NASH, BMI was the only independent predictor of the degree of fat infiltration (P = 0.003) 13 and histological examination in 33 potential living liver donors showed that BMI is a strong predictor of hepatic steatosis. 61 However, it has been shown that the abdominal distribution of fat is a predictor of hepatic steatosis, which is independent of body weight and body fat. 62 In a study on 221 biopsy-proven chronic hepatitis C patients, visceral fat distribution rather than BMI proved to be associated with steatosis (P < 0.001).…”