Assessment of donor fatty livers for liver transplantation

Aim. The effect of fatty Liver on graft survival, especially with reference to macrovesicular and microvesicular steatosis, is still uncertain. This p reliminarily study was designed to create a noninvasive method for the quan tification of the hepatic fat content in vivo and to establish provisional criteria for the assessment of fatty donor livers before liver transplantat ion among transplant surgeons, radiologists, and pathologists. Methods and Materials. Different degrees of rat fatty liver model were esta blished by feeding rats a diet deficient in choline and methionine for diff erent periods of time. Computed tomography (CT) with test tubes containing variable percentages of fat equivalent substance were used to assess the se verity of fatty change of the rat liver. This was then correlated with the histological classification, level of hepatic enzymes, and graft survival, Results. Linear correlation between the fat volume fraction added to the te st tubes and CT density were found. The process of producing a fatty liver via diet alteration peaked at week 3. At this time hepatic enzymes, radiolo gical fat content, and posttransplantation survival were worse (P=0.013), c ompared with other time points. Radiological assessment of fatty liver corr elated well with survival and serum glutamic oxaloacetic transaminase and g lutamic pyruvate transaminase levels. Conclusion. Severe microvesicular steatosis does not influence recipient su rvival, however, macrovesicular steatosis affects graft survival. Caliber C T is a practical and simple method that allows an accurate noninvasive quan titative assessment of hepatic fatty infiltration. It has potential to be a useful parameter for the assessment of donor livers for clinical liver tra nsplantation.