Adalı Gupse, Bozkurt Birkan, Ceyhan Özgür, Server Sadık, Doğusoy Gülen Bülbül, Yüzer Yıldıray, Tokat Yaman
Department of Gastroenterology, Istanbul Bilim University, Florence Nightingale Hospital Liver Unit, Istanbul, Turkey.
Department of General Surgery, Istanbul Bilim University, Florence Nightingale Hospital Liver Unit, Istanbul, Turkey.
Transplant Proc. 2019 Sep;51(7):2373-2378. doi: 10.1016/j.transproceed.2019.02.047. Epub 2019 Aug 8.
In living-donor liver transplantation, donor hepatic steatosis is crucial for both the donor and the recipient. Body mass index (BMI) and the unenhanced computed tomography liver attenuation index (CT LAI) are noninvasive methods to predict hepatic steatosis in living-donor liver candidates.
To analyze the diagnostic accuracy of CT LAI in conjunction with different BMI values for macrovesicular steatosis in living-donor liver candidates.
A total of 264 potential liver donors were included. The diagnostic accuracy of 2 CT LAI cut-offs and 3 BMI cut-off values for the assessment of hepatic steatosis ≥15% and ≤5% was determined.
Using CT LAI, the area under the receiver operating characteristic curve was 0.97 (95% CI = 0.89-0.99) for hepatic steatosis ≥15% in donors with BMI <25 kg/m. For detecting hepatic steatosis ≥15%, a CT LAI ≤0 had specificities of 100%, 76.2%, and 55.6% and positive predictive values of 100%, 95.5%, and 93.5% for patients with BMI values <25 kg/m, 25 to 29.9 kg/m, and ≥30 kg/m, respectively. According to logistic regression analyses, only CT LAI ≤0 was found to be independently associated with hepatic steatosis ≥15%.
In donors with BMI <30 kg/m and a CT LAI value >6, liver biopsy might be avoided. Biopsy may be reserved solely for donors with CT LAI value >0 and BMI ≥30 kg/m as the diagnostic accuracy of computed tomography for predicting hepatic steatosis decreases with increasing BMI.
在活体肝移植中，供体肝脂肪变性对供体和受体都至关重要。体重指数（BMI）和非增强计算机断层扫描肝脏衰减指数（CT LAI）是预测活体肝供体肝脂肪变性的非侵入性方法。
分析CT LAI结合不同BMI值对活体肝供体大泡性脂肪变性的诊断准确性。
共纳入264名潜在肝供体。确定了2个CT LAI临界值和3个BMI临界值对肝脂肪变性≥15%和≤5%评估的诊断准确性。
使用CT LAI，BMI<25kg/m的供体中，肝脂肪变性≥15%时，受试者操作特征曲线下面积为0.97（95%CI=0.89-0.99）。对于检测肝脂肪变性≥15%，CT LAI≤0时，BMI值<25kg/m、25至29.9kg/m和≥30kg/m的患者特异性分别为100%、76.2%和55.6%，阳性预测值分别为100%、95.5%和93.5%。根据逻辑回归分析，仅发现CT LAI≤0与肝脂肪变性≥15%独立相关。
对于BMI<30kg/m且CT LAI值>6的供体，可避免肝活检。活检可仅保留给CT LAI值>0且BMI≥30kg/m的供体，因为计算机断层扫描预测肝脂肪变性的诊断准确性随BMI增加而降低。
