First, do no harm: The question of liver biopsy in living liver donors

Introduction Hepatic steatosis (HS) negatively impacts transplant outcomes in living liver donors. To date, liver biopsy is preferred for HS evaluation. This study aims to evaluate the measurement of controlled attenuation parameter (CAP) as a diagnostic tool of HS in living liver donors. Methods Candidates recruited to this study, conducted from April 2016 to February 2020, were potential donors who had undergone transient elastography using Fibroscan® and CAP measurements at liver segments VI and VII, followed by liver biopsy. The HS grades from liver biopsy were classified as S0 (<5%), S1 (5–33%), S2 (33–66%), and S3 (>66%). For CAP, they were S0 (≤218dB/m), S1 (218-249dB/m)), S2 (250-305dB/m)), and S3 (>305dB/m)). The CAP measurements were compared with the liver biopsy results. Results Of the 150 potential donors [male, 73.3%; mean age, 30.0±7.0 years; body mass index (BMI), 24.7±3.5kg/m2], 92 (61.3%) had no or mild HS, while 58 (38.7%) and 10% had moderate to severe HS based on CAP and liver biopsy, respectively. Subjects with moderate to severe HS per CAP were mostly males (0.014), and had higher BMI (p = .006), alanine aminotransferase (ALT) (.001), gamma-glutamyl transferase (.026), and high-density lipoprotein (.008). On multivariate analysis, high ALT (OR, 1.051; 95% CI, 1.016–1.087; p = .004) was a predictor of significant HS. The sensitivity, specificity, positive and negative predictive values of CAP to detect significant HS were 93.3%, 67.4, 24.1%, and 98.9%, respectively. Conclusion The high sensitivity and negative predictive values of CAP make it a good screening test to exclude significant HS in potential living liver donors which, in turn, can help avoid unnecessary liver biopsies.

Download Full-text

Donor Liver Attenuation Index and Liver Biopsy Correlation in Living Donor Liver Transplantation

10.53350/pjmhs211571772 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1772-1775

Author(s):

Amer Latif ◽

Sumbul Naz ◽

Faisal Naseer ◽

Humaira Alam ◽

M. Afzal Bhatti ◽

...

Keyword(s):

Body Mass Index ◽

Liver Transplantation ◽

Liver Biopsy ◽

Hepatic Steatosis ◽

Body Mass ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Attenuation Index ◽

Living Liver Donors ◽

Liver Donors

Objective: Using non-invasive methods, such as BMI and CT LAIto suggest a prediction model for hepatic steatosis, examine the CT liver attenuation index and body mass index (BMI)association for pathological steatosis in living liver donors. Histological analysis remains the standard reference. Study Design: Retrospective study Place and Duration of Study: Liver Transplantation Department, Bahria International Hospital Orchard, Lahore from 1st June 2017 to 31st December 2018. Methodology: Fifty-nine donors were included with a median age of 23.00 years, as well as the potential donors for LDLT who experienced evaluation as a potential liver donor. Donors who underwent CT scan and histological liver evaluation were part of this study. Results: Of the donors, forty-eight (81.35%) had a CT LAI ≥1. The median BMI was 22.1 (range: 17.00–33.4). Twenty eight (47.5%) of the patients had undergone liver biopsy for screening in the pre-transplant period whereas 31 (52.5%) of the total evaluated donors underwent biopsy during the transplant. Thirty four (57.62%) out of 59 evaluated living liver donors underwent hepatectomy. Non-significant association (P=0.719) between different categories of BMI as the steatosis increases histologically, whereas significant association (P<.05) for CT LAI as the steatosis increases histologically. Conclusion: Body mass index alone is not a reliable factor for liver fat estimation non-enhanced CT liver-spleen attenuation index of ≤0 correspond to severe hepatic steatosis reserving histopathological liver evaluation via biopsy for selected cases and decreasing the need of liver biopsy while making sure both donor and recipient are safe. Keywords:Living donor liver transplantation, CT LAI, BMI, Liver biopsy

Download Full-text