Evaluation of Controlled Attenuation Parameter as a Tool for Assessment of Hepatic Steatosis in Living Liver Donors.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.