Department of Medicine, Columbia University Irving Medical Center, New York City, NY.
Columbia University Mailman School of Public Health, New York City, NY.
Transplantation. 2023 Sep 1;107(9):1991-1998. doi: 10.1097/TP.0000000000004581. Epub 2023 Mar 24.
The ability of vibration controlled transient elastography (VCTE) to reliably exclude significant steatosis in living donor candidates could obviate the need for invasive liver biopsies, expedite the donor approval process, and reduce recipient wait time. We therefore aimed to determine whether VCTE controlled attenuation parameter (CAP) could be used to detect steatosis in potential living donors.
Living donor candidates who presented for evaluation between 2016 and 2019 underwent standard donor workup, VCTE, and liver biopsy if indicated. CAP scores were compared with MRI-Fat Fraction and, when available, histologic fat fraction from liver biopsy. Receiver operating characteristic curves were used to identify cutoffs with appropriate sensitivity and specificity for screening. Statistical analysis was conducted using R (version 3.6.0).
Seventy-nine candidate living donors presented during the study period, of whom 71 were included in the final analysis and of whom 20 underwent liver biopsy. There was a positive correlation between MRI-Fat Fraction and CAP scores with an observed Spearman correlation coefficient of 0.424 ( P < 0.01). A CAP score of 271.5 dB/m or less was determined to have 89.8% sensitivity and 75% specificity for detecting <5% steatosis on MRI. The correlation between CAP and steatosis of available histologic samples had a Pearson correlation coefficient of 0.603 ( P = 0.005). A CAP cutoff of 276.0 dB/m demonstrated 66.7% sensitivity and 85.7% specificity for detecting <15% histopathologic steatosis and positive and negative predictive values of 71.5% and 82.7%, respectively.
VCTE can be integrated into living donor evaluation to accurately screen for hepatic steatosis.
振动控制瞬时弹性成像（VCTE）能够可靠地排除活体供者候选者中显著的脂肪变性，这可以避免进行侵入性肝活检，加快供者审批过程，并减少受者等待时间。因此，我们旨在确定 VCTE 控制衰减参数（CAP）是否可用于检测潜在活体供者的脂肪变性。
2016 年至 2019 年期间接受评估的活体供者候选者接受了标准供者检查、VCTE，如果需要，还接受了肝活检。将 CAP 评分与 MRI 脂肪分数进行比较，并在有条件的情况下，与肝活检的组织学脂肪分数进行比较。使用接收器操作特性曲线确定具有适当敏感性和特异性的用于筛查的截止值。统计分析使用 R（版本 3.6.0）进行。
在研究期间，有 79 名候选活体供者就诊，其中 71 名最终纳入分析，其中 20 名接受了肝活检。MRI 脂肪分数与 CAP 评分之间存在正相关，观察到的斯皮尔曼相关系数为 0.424（P<0.01）。CAP 评分≤271.5 dB/m 可检测到 MRI 上<5%的脂肪变性，其敏感性为 89.8%，特异性为 75%。CAP 与可获得的组织学样本中脂肪变性之间的相关性具有 Pearson 相关系数为 0.603（P=0.005）。CAP 截断值为 276.0 dB/m 时，对<15%组织病理学脂肪变性的敏感性为 66.7%，特异性为 85.7%，阳性预测值为 71.5%，阴性预测值为 82.7%。
VCTE 可整合到活体供者评估中，以准确筛查肝脂肪变性。
