Mehta Naimish N, Rajput Manmohan, Kumar Karan, Nagar Anand, Mahala Vinay K, Saraswat Vivek A, Mishra Akash
Department of Hepato Pancreato Biliary Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, India.
Department of Hepatology, Mahatma Gandhi Medical College and Hospital, Jaipur, India.
J Clin Exp Hepatol. 2025 Jul-Aug;15(4):102514. doi: 10.1016/j.jceh.2025.102514. Epub 2025 Feb 12.
Currently, there is an absence of a standardised protocol for the preoperative detection of hepatic steatosis (HS) in living liver donors. A steatotic liver graft jeopardises the outcome of the recipient with multiple potential complications. Vibration-controlled transient elastography (Fibroscan®) provides a controlled attenuation parameter (CAP), which we have utilised in our assessment of HS in living liver donors. This approach offers a promising avenue for the advancement of preoperative evaluation protocols.
In the period spanning from October 2022 to July 2024, a cohort of 67 liver donors were subjected to preoperative vibration-controlled transient elastography (Fibroscan®) and either preoperative or intraoperative liver biopsy. HS was defined as a fat content exceeding 10%. CAP readings were juxtaposed with liver biopsy results for the diagnosis of HS. Donors were categorised into three categories with HS <5%, 5-10% and those with HS >10% were rejected as per our institutional protocol. This facilitated a comprehensive evaluation of HS in the context of living donor liver transplantation.
CAP was very accurate in detecting HS, with an area under the receiver operating characteristic curve of 0.99 ( < 0.05). Statistical analysis determined that a CAP cutoff value of 266 dB/m provides a sensitivity of 100% and a specificity of 98.4% for predicting HS >10%. Corresponding positive predictive value (PPV) is 85.71%, while the negative predictive value is 100%. Univariate analysis determined body mass index (BMI), age and serum triglyceride levels were associated with CAP; however, multivariate linear regression revealed an association with only BMI ( < 0.001) and age ( < 0.002). When a lower fat threshold of 5% was considered to define HS with the same cut off of CAP, the sensitivity reduced to 66.7% and specificity was 98.3% The recipients of donors with HS of 5%-10% did not show any negative outcomes.
CAP demonstrates significant potential as a predictive tool for hepatic steatosis (HS) in living liver donors. Notably, BMI and age have been identified as independent factors associated with CAP values.
目前，活体肝供体术前肝脂肪变性（HS）检测尚无标准化方案。脂肪变性的肝移植物会因多种潜在并发症而危及受者的预后。振动控制瞬时弹性成像（Fibroscan®）可提供受控衰减参数（CAP），我们已将其用于评估活体肝供体的HS。这种方法为术前评估方案的改进提供了一条有前景的途径。
在2022年10月至2024年7月期间，对67名肝供体进行术前振动控制瞬时弹性成像（Fibroscan®）检查，并进行术前或术中肝活检。HS定义为脂肪含量超过10%。将CAP读数与肝活检结果并列用于HS的诊断。根据我们的机构方案，将供体分为三类，HS<5%、5-10%，而HS>10%的供体被拒绝。这有助于在活体肝移植背景下对HS进行全面评估。
CAP在检测HS方面非常准确，受试者工作特征曲线下面积为0.99（<0.05）。统计分析确定，CAP临界值为266 dB/m时，预测HS>10%的灵敏度为100%，特异性为98.4%。相应的阳性预测值（PPV）为85.71%，阴性预测值为100%。单因素分析确定体重指数（BMI）、年龄和血清甘油三酯水平与CAP相关；然而多变量线性回归显示仅与BMI（<0.001）和年龄（<0.002）相关。当将较低的脂肪阈值5%视为定义HS且CAP临界值相同时，灵敏度降至66.7%，特异性为98.3%。HS为5%-10%的供体的受者未出现任何不良后果。
CAP作为活体肝供体肝脂肪变性（HS）的预测工具具有显著潜力。值得注意的是，BMI和年龄已被确定为与CAP值相关的独立因素。
