Ryan Charlotte K, Johnson Lesley A, Germin Barbara I, Marcos Amadeo
Department of Pathology and Laboratory Medicine and Division of Transplantation, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
Liver Transpl. 2002 Dec;8(12):1114-22. doi: 10.1053/jlts.2002.36740.
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. BMI correlated only weakly with biopsy, with 73% of overweight (BMI > 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 afforded by BMI 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 grafts at risk for poor recipient outcome while maximizing the donor pool.
活体肝移植使越来越多的终末期肝病患者在尸体器官严重短缺的情况下有机会获得有效治疗。肝脂肪变性会减少功能性移植肝体积，并可能导致移植肝功能障碍。筛查性肝活检可准确量化肝脏脂肪，但这是一种侵入性操作，在活体供体评估中并非普遍采用。我们研究了连续100例前瞻性右叶活体供体，所有供体均接受了肝活检、影像学检查及各种临床参数评估。在确定肝脏脂肪含量方面，将体重指数（BMI）和影像学检查的准确性及预测价值与活检结果进行了比较。肝活检无并发症发生，33%的供体显示有一定程度的脂肪变性。BMI与活检结果仅呈弱相关，73%超重（BMI>25）的供体几乎没有或没有肝脏脂肪。影像学检查对少量（5%至10%）脂肪的敏感度仅为12%，对更严重脂肪变性的敏感度则增加。影像学检查诊断出2例无肝脏脂肪的供体有脂肪变性，却未能识别出1例经活检证实有30%脂肪变性而被拒绝的供体。相反，BMI为25或更低的供体中有9%有10%或更高的脂肪变性。此外，有3例供体因活检检测出隐匿性肝病而被拒绝手术。仅靠BMI和影像学检查无法准确量化肝脏脂肪。筛查性肝活检并发症发生率低，可能有助于提高供体安全性。活检对于识别有导致受体预后不良风险的供体移植物以及最大限度扩大供体库至关重要。
