One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation

Abstract

Living donor liver transplantation allows an increasing number of patients with end-stage liver disease the opportunity for effective treatment in the face of a critical shortage of cadaveric organs. Hepatic steatosis decreases functional graft mass and may contribute to graft dysfunction. Screening liver biopsy allows accurate quantitation of hepatic fat, but is an invasive procedure that is not universally employed in the evaluation of living donors. We studied 100 consecutive prospective right lobe living donors, all evaluated with liver biopsy, imaging studies, and various clinical parameters. The accuracy and predictive value of body mass index (BMI) and imaging were compared with biopsy in determining the amount of hepatic fat. There were no complications to biopsy, with 33% showing some degree of steatosis. BM1 correlated only weakly with biopsy, with 73% of overweight (BM1 > 25) donors having little or no hepatic fat. Imaging was only 12% sensitive to small amounts (5% to 10%) of fat, with increasing sensitivity to more severe steatosis. Imaging diagnosed steatosis in 2 donors without hepatic fat and failed to identify a candidate denied with biopsy-proven 30% steatosis. Conversely, 9% of candidates with BMIs of 25 or less had 10% or greater steatosis. Moreover, three candidates were denied surgery because biopsy detected occult liver disease. Accurate quantification of hepatic fat is not afTorded by BM1 and imaging studies alone. Screening liver biopsy has a low complication rate and may serve to increase donor safety. Biopsy is essential in identifying donor g r a f t s at risk for poor recipient outcome while maximizing the donor pool.

Effect of Short-Term Vitamin D Correction on Hepatic Steatosis as Quantified by Controlled Attenuation Parameter (CAP)

“…Despite weight loss, no improvements in hepatic steatosis assessed using ultrasonography or in LFTs were noted. However, ultrasonography has been reported to have markedly lower sensitivity when compared to CAP for detecting liver fat, particularly with < 30% liver fat infiltration [38,39]. In contrast, the patients herein displayed reduced liver fat contents, despite no alterations in body composition during the six months.…”

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.…”

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

“…In individual patients, especially in tertiary care centres, steatosis should be identified by imaging, preferably US, because it is more widely available and cheaper than the gold standard, MRI (ESM 1 Table 2). US has limited sensitivity and does not reliably detect steatosis when <20% [27,28] or in individuals with high body mass index (BMI) (>40 kg/m 2 ) [29]. Despite observer dependency, US (or computed tomography [CT] or MRI) robustly diagnoses moderate and severe steatosis and provides additional hepatobiliary information, hence it should be performed as a first-line diagnostic test.…”