Yen Y H, Kuo F Y, Lin C C, Chen C L, Chang K C, Tsai M C, Hu T H
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pathology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2018 Dec;50(10):3533-3538. doi: 10.1016/j.transproceed.2018.06.039. Epub 2018 Jun 30.
Hepatic steatosis (HS) can cause substantial problems for both donors and recipients in living donor liver transplantation. The controlled attenuation parameter (CAP) is a noninvasive method of measuring HS using a process based on transient elastography.
To evaluate the accuracy of CAP in quantifying HS during living donor liver transplantation.
A total of 54 liver donors who received CAP and intraoperative liver biopsy (LB) were enrolled in this study. The performance of CAP compared with LB for diagnosing HS was assessed using areas under receiver operating characteristic curves. HS was defined by the presence of steatosis in >5% of hepatocytes.
No HS was found in 47 donors, while the remaining 7 donors showed HS ranging from 10% to 30%. Using CAP, the area under receiver operating characteristic curve was 0.96 (95% CI, 0.91-1; P < .001) for HS; the optimal cutoff value for HS was 257 dB/m (sensitivity: 100%, specificity: 89.4%, positive predictive value: 58.3%, negative predictive value: 100%). Among the 42 candidates with CAP <257 dB/m, none had HS, while of the 12 candidates with CAP ≥257 dB/m, 7 had HS. In a multivariate linear regression analyses, body mass index (β = 0.71, P < .001) was found to be independently associated with CAP in those without HS.
CAP might be a promising tool to exclude HS in East Asian living liver donors. Body mass index was found to be independently associated with CAP values in those without HS.
肝脂肪变性（HS）在活体肝移植中会给供体和受体带来诸多严重问题。受控衰减参数（CAP）是一种基于瞬时弹性成像技术的无创测量HS的方法。
评估CAP在活体肝移植中量化HS的准确性。
本研究纳入了54例接受CAP检查和术中肝活检（LB）的肝供体。采用受试者操作特征曲线下面积评估CAP与LB诊断HS的性能。HS定义为>5%的肝细胞存在脂肪变性。
47例供体未发现HS，其余7例供体的HS范围为10%至30%。使用CAP，HS的受试者操作特征曲线下面积为0.96（95%CI，0.91 - 1；P <.001）；HS的最佳截断值为257 dB/m（敏感性：100%，特异性：89.4%，阳性预测值：58.3%，阴性预测值：100%）。在42例CAP <257 dB/m的候选者中，无一例有HS，而在12例CAP≥257 dB/m的候选者中，7例有HS。在多变量线性回归分析中，发现体重指数（β = 0.71，P <.001）在无HS的患者中与CAP独立相关。
CAP可能是排除东亚活体肝供体HS的一种有前景的工具。发现体重指数在无HS的患者中与CAP值独立相关。
