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01-04-2020 | Original Scientific Report

A Model to Predict Significant Macrosteatosis in Hepatic Grafts

Authors: Ahmed Swelam, René Adam, Lelde Lauka, Luiza Basilio Rodrigues, Sherif Elgarf, Mylène Sebagh, Nicolas Golse, Antonio Sa Cunha, Daniel Cherqui, Denis Castaing, Marc-Antoine Allard

Published in: World Journal of Surgery | Issue 4/2020

Abstract

Background and aims

Assessing the risk of significant macrosteatosis in donors is crucial before considering hepatic graft procurement. We aimed to build a model to predict significant macrosteatosis based on noninvasive methods.

Methods

From January 2012 to December 2018, liver attenuation indices and liver-to-spleen (L/S) ratio were measured in 639 brain-dead donors by local radiologists. Quantity and quality of steatosis were evaluated by an expert pathologist, blinded for attenuation indices measurement.

Results

Macrosteatosis ≥ 30% was found in 33 donors (5.2%). Body weight, body mass index (BMI), abdominal perimeters, history of alcohol abuse, L/S ratio, and liver parenchyma attenuation were associated with macrosteatosis ≥ 30%. The L/S ratio, BMI, and a history of alcohol abuse remained independent predictors in multivariate analysis and were used to build a predictive model (C-index: 0.77). The optimal cutoff to predict macrosteatosis ≥ 60% was 0.85.

Conclusion

Our model, including L/S ratio, BMI, and history of alcohol, might be helpful to refine indication for liver biopsy before donation after brain death. External validation is required.

McCormack L, Petrowsky H, Jochum W et al (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245:923–930. https://doi.org/10.1097/01.sla.0000251747.80025.b7 CrossRefPubMedPubMedCentral

Nocito A, El-Badry AM, Clavien P-A (2006) When is steatosis too much for transplantation? J Hepatol 45:494–499. https://doi.org/10.1016/j.jhep.2006.07.017 CrossRefPubMed

Behrns K (1998) Hepatic steatosis as a potential risk factor for major hepatic resection. J Gastrointest Surg 2:292–298. https://doi.org/10.1016/S1091-255X(98)80025-5 CrossRefPubMed

Angulo P (2002) Nonalcoholic fatty liver disease. N Engl J Med 346:1221–1231. https://doi.org/10.1056/NEJMra011775 CrossRefPubMed

McCormack L, Dutkowski P, El-Badry AM, Clavien P-A (2011) Liver transplantation using fatty livers: always feasible? J Hepatol 54:1055–1062. https://doi.org/10.1016/j.jhep.2010.11.004 CrossRefPubMed

Ureña MAG, Ruiz-Delgado FC, González EM et al (1998) Assessing risk of the use of livers with macro and microsteatosis in a liver transplant program. Transpl Proc 30:3288–3291. https://doi.org/10.1016/S0041-1345(98)01033-1 CrossRef

Buscarini L, Fornari F, Bolondi L et al (1990) Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications a retrospective study on 2091 biopsies. J Hepatol 11:344–348CrossRef

Bydder G, Chapman R, Harry D et al (1981) Computed tomography attenuation values in fatty liver. J Comput Tomogr 5:33–35CrossRef

Ducommun J-C, Goldberg HI, Korobkin M et al (1979) The relation of liver fat to computed tomography numbers: a preliminary experimental study in rabbits. Radiology 130:511–513CrossRef

10.

Johnston RJ, Stamm ER, Lewin JM et al (1998) Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements. Abdom Imaging 23:409–415. https://doi.org/10.1007/s002619900370 CrossRefPubMed

11.

Rogier J, Roullet S, Cornélis F et al (2015) Noninvasive assessment of macrovesicular liver steatosis in cadaveric donors based on computed tomography liver-to-spleen attenuation ratio: assessment of liver steatosis. Liver Transpl 21:690–695. https://doi.org/10.1002/lt.24105 CrossRefPubMed

12.

Kodama Y, Ng CS, Wu TT et al (2007) Comparison of CT methods for determining the fat content of the liver. Am J Roentgenol 188:1307–1312. https://doi.org/10.2214/AJR.06.0992 CrossRef

13.

Ricci C, Longo R, Giolius E et al (1997) Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol 27:108–113. https://doi.org/10.1016/S0168-8278(97)80288-7 CrossRefPubMed

14.

Park SH, Kim PN, Kim KW et al (2006) Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 239:105–112. https://doi.org/10.1148/radiol.2391050361 CrossRefPubMed

15.

Kan H, Kimura Y, Hyogo H et al (2014) Non-invasive assessment of liver steatosis in non-alcoholic fatty liver disease: L/S ratio of liver steatosis. Hepatol Res 44:E420–E427. https://doi.org/10.1111/hepr.12330 CrossRefPubMed

16.

Pickhardt PJ, Park SH, Hahn L et al (2012) Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 22:1075–1082. https://doi.org/10.1007/s00330-011-2349-2 CrossRefPubMed

17.

Birnbaum BA, Hindman N, Lee J, Babb JS (2007) Multi-detector row CT attenuation measurements: assessment of intra- and interscanner variability with an anthropomorphic body CT phantom. Radiology 242:109–119. https://doi.org/10.1148/radiol.2421052066 CrossRefPubMed

18.

Lieber CS (1970) New pathway of ethanol metabolism in the liver. Gastroenterology 59:930–937CrossRef

19.

Lieber CS, DeCarli LM (1991) Hepatotoxicity of ethanol. J Hepatol 12:394–401CrossRef

20.

Donohue T (2007) Alcohol-induced steatosis in liver cells. World J Gastroenterol 13:5

21.

Angulo P (2002) Nonalcoholic fatty liver disease. N Eng J Med 346:1221–1231CrossRef

22.

Harrison SA (2015) NASH, from diagnosis to treatment: where do we stand? Hepatology 62:1652–1655. https://doi.org/10.1002/hep.28275 CrossRefPubMed

23.

Kim D, Kim WR (2017) Nonobese fatty liver disease. Clin Gastroenterol Hepatol 15:474–485. https://doi.org/10.1016/j.cgh.2016.08.028 CrossRefPubMed

24.

Dasarathy S, Dasarathy J, Khiyami A et al (2009) Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study q. J Hepatol 51:1061–1067. https://doi.org/10.1016/j.jhep.2009.09.001 CrossRefPubMedPubMedCentral

25.

Mikolasevic I, Orlic L, Franjic N et al (2016) Transient elastography (FibroScan^®) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease—where do we stand? World J Gastroenterol 22:7236–7251. https://doi.org/10.3748/wjg.v22.i32.7236 CrossRefPubMedPubMedCentral

26.

De Lédinghen V, Vergniol J, Capdepont M et al (2014) Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol 60:1026–1031. https://doi.org/10.1016/j.jhep.2013.12.018 CrossRefPubMed

27.

Schwenzer NF, Springer F, Schraml C et al (2009) Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 51:433–445. https://doi.org/10.1016/j.jhep.2009.05.023 CrossRefPubMed

28.

Middleton MS, Heba ER, Hooker CA et al (2017) Density fat fraction measurements and pathologist-assigned nonalcoholic steatohepatitis. Gastroenterology 153:753–761. https://doi.org/10.1053/j.gastro.2017.06.005 CrossRefPubMedPubMedCentral

29.

Golse N, Cosse C, Allard M-A et al (2018) Evaluation of a micro-spectrometer for the real-time assessment of liver graft mild-to-moderate macrosteatosis: a proof of concept study. J Hepatol. https://doi.org/10.1016/j.jhep.2018.10.034 CrossRefPubMed

30.

Kleiner DE, Brunt EM, Van Natta M et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatol Baltim Md 41:1313–1321. https://doi.org/10.1002/hep.20701 CrossRef

Title: A Model to Predict Significant Macrosteatosis in Hepatic Grafts
Authors: Ahmed Swelam
René Adam
Lelde Lauka
Luiza Basilio Rodrigues
Sherif Elgarf
Mylène Sebagh
Nicolas Golse
Antonio Sa Cunha
Daniel Cherqui
Denis Castaing
Marc-Antoine Allard
Publication date: 01-04-2020
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 4/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05330-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A Model to Predict Significant Macrosteatosis in Hepatic Grafts

Abstract

Background and aims

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusion

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