Characterization of hepatic steatosis using controlled attenuation parameter and MRI‐derived proton density fat fraction in living donor liver transplantation

Abstract

Background:The increasingly favorable outcomes of live donor liver transplant warrant development of screening techniques to expand current donor pool. Transient elastography (TE) with controlled attenuation parameter (CAP) is accessible and has promising diagnostic performance in non-obese individuals. Here, we demonstrate its utility in grading donor steatosis for risk assessment in living liver donors (LLD). Study Design:In a prospective study of LLD and recipients, accuracy was determined using MRI-derived proton density fat fraction (PDFF) as reference.Results: One hundred and one LLD underwent TE, 95 of whom had available PDFF.Median CAP and MRI-PDFF were 233 dB/m (206-270) and 2.9% (2.3-4.0), respectively. A CAP threshold of 270 dB/m captured all steatosis which was present in 13 (13%) LLD (AUROC .942, 100% sensitivity and 83% specificity). Performance further improved when excluding obese LLD and limiting analysis to M-probe (AUROC .971 and .974, respectively, with 87% specificity). There was no difference in CAP and MRI-PDFF between LLD and nondonors (P = .26 and .21, respectively). Early allograft dysfunction was observed in one recipient (CAP 316, PDFF 9.5%), zero underwent retransplant, and one died from sepsis. Conclusion:The specific role of CAP in living liver donation warrants further study, beginning with its use as screening tool across peripheral clinics.

Subcutaneous Fat Obesity in a High Body Mass Index Donor Is Not a Contraindication to Living Donor Hepatectomy

“…MRI is the most accurate among the imaging modalities but also more expensive. It can also assess for microsteatosis and, hence, give a better idea about the overall quality of the graft [ 7 , 8 ]. Higher volume centers usually prefer MRI more than low-volume centers [ 1 ].…”

Noninvasive assessment of liver fibrosis and portal hypertension

“…Furthermore, an LSM more than 11 kPa has been associated with decreased overall survival [22 ▪ ] and an adverse cardiometabolic profile (D. Hugues, in preparation). Finally, TE-LSM has also been used to identify allograft quality both in deceased and living liver donors [23].…”

Will noninvasive screening for fibrosis/steatosis open Pandora’s box? Sharing the healthcare burden of state-of-the-art hepatology practice

“…It is plausible that for screening people without known NAFLD, lower cutoff values will be needed (eg, 270 dB/m) to maximize sensitivity, although this possibility was not explored. [9] Regardless of the CAP threshold, they demonstrated a dose-dependent relationship between CAP and mortality, further suggesting that steatosis exists on a spectrum of mild to severe disease rather than a phenomenon with discrete inflection points. This is similar to LDL cholesterol and its impact on the atherosclerotic cardiovascular risk disease model, although CAP's dose-dependent relationship with mortality needs to be reproduced in more prospective studies.…”

“…Vilar-Gomez and colleagues utilized a threshold of 285 dB/m with prior validation in patients with biopsy-proven NAFLD. It is plausible that for screening people without known NAFLD, lower cutoff values will be needed (eg, 270 dB/m) to maximize sensitivity, although this possibility was not explored 9. Regardless of the CAP threshold, they demonstrated a dose-dependent relationship between CAP and mortality, further suggesting that steatosis exists on a spectrum of mild to severe disease rather than a phenomenon with discrete inflection points.…”