Steatosis among living liver donors without evidence of fatty liver on ultrasonography: potential implications for preoperative liver biopsy

Abstract

Background: The degree of steatosis is an important factor that determines the graft function in the recipient and the recovery of the remnant liver in the living donor. To date, there is no consensus regarding how to assess steatosis among potential living liver donors. We evaluate the prevalence and risk factors for steatosis in living liver donors with normal serum aminotransferase levels and without fatty liver on ultrasonography (US-negative).

Methods: The degree of steatosis was assessed for a total of 492 US-negative living liver donors with normal aminotransferase levels (age 30.1±9.9; male 301 [61.2%]). Total steatosis was defined by adding the degree of macrosteatosis and microsteatosis.

Results: No liver donor had a severe degree (≥60%) of macrosteatosis or microsteatosis. A moderate degree (30-59%) of macrosteatosis and microsteatosis was seen in 4 (0.8%) and 26 (5.3%) subjects, respectively. Severe and moderate degrees of total steatosis were seen in 3 (0.6%) and 53 (10.8%) subjects, respectively. Body mass index and serum triglyceride levels were independent factors associated with the moderate or greater degree of total steatosis.

Conclusions: Noninvasive preoperative assessment for liver steatosis (US-negative with normal aminotransferase level) was sufficient to exclude severe macrosteatosis or microsteatosis and moderate macrosteatosis but not sufficient to exclude moderate microsteatosis or total steatosis in living liver donors.