Session Name: Liver: Living Donor Liver Transplant and Partial Grafts
Session Date & Time: None. Available on demand.
*Purpose: The aim of this study is to assess the diagnostic yield of selective pre-donation liver biopsy in living donor liver candidates and its impact on donor selection.
*Methods: We reviewed all liver biopsies performed at our center from 8/1/2016 to 10/5/2020 as part of living donor liver evaluation. Donors underwent pre-donation protocol biopsy if any of the following were present: BMI≥28 kg/m2, positive anti-nuclear or smooth muscle antibody, 1st degree relative of recipient with autoimmune liver disease (AILD) (PSC, PBC, AIH), heterozygote (Hz) for alpha-1-antitrypsin (A1AT) deficiency, steatosis on cross-sectional imaging, or at discretion of evaluating hepatologist. All donors who did not meet criteria for pre-donation biopsy underwent intraoperative biopsy at time of donation.
*Results: A total of 70 pre-donation liver biopsies were performed (27% of donors evaluated during this time). The leading indication for biopsy was BMI>28 (43%), ANA (27%), 1st degree relative with AILD (17%), A1AT Hz (13%). A total of 19 patients (27%) had abnormal biopsies. Of these, 11 (16% of total donors biopsied) were excluded from donation based on biopsy results. Steatohepatitis was the most common histologic abnormality that precluded donation (5/11) followed by non-specific portal inflammation (3/11). Of 30 patients with a BMI>28, 6 had abnormal biopsies (including 4 who had steatohepatitis). Of 18 patients with positive ANA, only 3 had abnormal biopsies, all of whom had high titer ANA (≥1:160). Of 12 patients biopsied due to 1st degree relative with AILD (included 4 with positive ANA), all had normal biopsies. No patients that were A1AT heterozygotes (9) had abnormal biopsies (including PAS-D granules). No major complications of donor biopsies were reported. All intraoperative donor biopsies of individuals that did not meet criteria for pre-donation biopsy were normal.
*Conclusions: Liver biopsy remains an important component of living liver donor evaluation, however, more focused patient selection criteria should be considered and ideally, be informed by additional multicenter studies.
To cite this abstract in AMA style:Cisek J. Elevated BMI (>28) and High Titer ANA are the Most Common Causes of Abnormal Selective Pre-donation Liver Biopsies in Living Liver Donors [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/elevated-bmi-28-and-high-titer-ana-are-the-most-common-causes-of-abnormal-selective-pre-donation-liver-biopsies-in-living-liver-donors/. Accessed January 19, 2022.
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