Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases and Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Liver Transplantation Program, University of Arkansas for Medical Sciences, Little Rock, AR.
Transplantation. 2022 Feb 1;106(2):318-327. doi: 10.1097/TP.0000000000003720.
Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) are noninvasive surrogates for hepatic steatosis and fibrosis, respectively, and could help identify extended criteria donors in liver transplantation (LT). We aimed to determine the accuracy of CAP/LSM in deceased donors along with post-LT changes.
Accuracy of preprocurement CAP/LSM to grade/stage steatosis/fibrosis was determined using liver biopsy as reference. Transplant outcomes, including primary nonfunction (PNF) and early allograft dysfunction, were recorded. Recipients underwent CAP/LSM as outpatients. Areas under the receiver operating characteristic curve and regression models were constructed to analyze data.
We prospectively evaluated 160 allografts (138 transplanted). Same-probe paired baseline/post-LT CAP was 231 dB/m (181-277)/225 (187-261) (P = 0.61), and LSM 7.6 kPa (6.3-10.8)/5.9 (4.6-8.7) (P = 0.002), respectively. CAP reading was affected by BMI and LSM by ALT, race and bilirubin. Although CAP did not correlate with steatosis from frozen sections (ρ = 0.08, P = 0.47), it correlated with steatosis from permanent sections (ρ = 0.32, P < 0.001) and with oil red O histomorphometry (ρ = 0.35, P = 0.001). CAP identified moderate-to-severe steatosis with an areas under the receiver operating characteristic curve curve of 0.79 (0.66-0.91), for a negative predictive value of 100% at a cutoff value of 230 dB/m. LSM correlated with fibrosis staging (ρ = 0.22, P = 0.007) and it identified discarded allografts with advanced fibrosis/cirrhosis. Patients with no to minimal fibrosis had an LSM of 7.6 (6-10.1) kPa.
Our results are proof-of-concept of the utility of CAP/LSM during organ procurement. Establishing the precise role of these noninvasive tools in the organ allocation process mandates confirmatory studies.
受控衰减参数（CAP）和肝硬度测量（LSM）分别是非酒精性脂肪性肝病和纤维化的非侵入性替代指标，有助于确定肝移植（LT）中的扩展标准供体。我们旨在确定供体死亡时 CAP/LSM 的准确性以及移植后的变化。
使用肝活检作为参考，确定术前 CAP/LSM 对脂肪变性/纤维化分级/分期的准确性。记录原发性无功能（PNF）和早期移植物功能障碍等移植结果。受者作为门诊患者接受 CAP/LSM 检查。构建受试者工作特征曲线和回归模型来分析数据。
我们前瞻性评估了 160 个同种异体移植物（138 个移植）。相同探头的基线/移植后 CAP 分别为 231dB/m（181-277）/225dB/m（187-261）（P=0.61），LSM 分别为 7.6kPa（6.3-10.8）/5.9kPa（4.6-8.7）（P=0.002）。CAP 读数受 BMI 影响，LSM 受 ALT、种族和胆红素影响。尽管 CAP 与冷冻切片的脂肪变性无相关性（ρ=0.08，P=0.47），但与永久切片的脂肪变性（ρ=0.32，P<0.001）和油红 O 组织形态计量学有相关性（ρ=0.35，P=0.001）。CAP 对中重度脂肪变性的曲线下面积为 0.79（0.66-0.91），截断值为 230dB/m 时阴性预测值为 100%。LSM 与纤维化分期相关（ρ=0.22，P=0.007），可识别出有晚期纤维化/肝硬化的废弃供体。无至轻度纤维化患者的 LSM 为 7.6kPa（6-10.1）kPa。
我们的结果证明了 CAP/LSM 在器官获取过程中的实用性。证实这些非侵入性工具在器官分配过程中的精确作用需要进一步的研究。
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