Yamashiki Noriyo, Sugawara Yasuhiko, Tamura Sumihito, Kaneko Junichi, Matsui Yuichi, Togashi Junichi, Ohki Takamasa, Yoshida Haruhiko, Omata Masao, Makuuchi Masatoshi, Kokudo Norihiro
Organ Transplantation Service, University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
Transplantation. 2009 Aug 27;88(4):575-81. doi: 10.1097/TP.0b013e3181b11c19.
Hepatic steatosis in the donor liver is associated with an increased risk of complications after liver transplantation. Mandatory liver biopsy for all potential donors, however, remains controversial. To define clinico-pathological correlation, we reviewed our criteria for liver biopsy and examined the use of visceral fat area (VFA) estimation by computed tomography image.
Our criteria for biopsy are as follows: an aspartate aminotransferase/alanine aminotransferase ratio of less than 1, a body mass index more than or equal to 25 kg/m2, and a suspected fatty liver on ultrasonography. Dietary intervention is indicated for overweight donor candidates and for those with more than 10% hepatic steatosis. Clinical data of consecutive 78 potential donors who underwent percutaneous liver biopsy (biopsy group) and 70 donors whose biopsy were omitted (control group) were reviewed.
Donors in biopsy group were male dominant with a median age of 35 (20-63) years. Hepatic steatosis more than or equal to 10% was seen in nine of 78 donors; older age (P=0.012), ultrasonographic findings (P=0.002), VFA (P=0.008), and percent VFA (VFA/[VFA+subcutaneous fat area]; P=0.009) were associated with more than 10% hepatic steatosis. The area under the receiver operating characteristics curve of VFA and percent VFA for detecting hepatic steatosis more than or equal to 10% were 0.803 and 0.778, respectively. Hepatic steatosis was successfully reduced to less than 10% through dietary intervention in six of the nine donor candidates.
Our current biopsy criteria are acceptable to select donor candidates at risk for hepatic steatosis. Visceral fat measurement can be used as an additional factor to narrow donors at risk and to monitor visceral fat reduction during dietary intervention.
供体肝脏的肝脂肪变性与肝移植术后并发症风险增加相关。然而，对所有潜在供体进行强制性肝活检仍存在争议。为了明确临床病理相关性，我们回顾了肝活检标准，并通过计算机断层扫描图像检查了内脏脂肪面积（VFA）估计值的应用情况。
我们的活检标准如下：天冬氨酸转氨酶/丙氨酸转氨酶比值小于1、体重指数大于或等于25kg/m²以及超声检查怀疑有脂肪肝。对于超重的供体候选者以及肝脂肪变性超过10%的供体候选者，建议进行饮食干预。回顾了连续78例接受经皮肝活检的潜在供体（活检组）和70例未进行活检的供体（对照组）的临床资料。
活检组供体以男性为主，中位年龄为35（20 - 63）岁。78例供体中有9例肝脂肪变性大于或等于10%；年龄较大（P = 0.012）、超声检查结果（P = 0.002）、VFA（P = 0.008）以及VFA百分比（VFA/[VFA + 皮下脂肪面积]；P = 0.009）与肝脂肪变性超过10%相关。用于检测肝脂肪变性大于或等于10%的VFA和VFA百分比的受试者工作特征曲线下面积分别为0.803和0.778。通过饮食干预，9例供体候选者中有6例的肝脂肪变性成功降至10%以下。
我们目前的活检标准可用于选择有肝脂肪变性风险的供体候选者。内脏脂肪测量可作为一个附加因素，用于缩小有风险的供体范围，并在饮食干预期间监测内脏脂肪减少情况。
