Introduction: Estimation of hepatic steatosis is an important variable in determining suitability of a donor liver allograft for transplantation. Differentiation between and quantification of macro- and microsteatosis has a high degree of inter-observer variability and can have significant impact on organ utilization.

Methods: We compared on-site biopsy estimation (OS) of hepatic steatosis from UNOS pathology reports with final back-table biopsy (BT) biopsy assessment at our center. Donor OS biopsy data was available for 200 livers transplanted at our center from June 2015 through June 2017. Allografts with OS estimated macrosteatosis >30% were considered “fatty donor” (FD, N=49) and were compared with standard donors (SD, N=151) with OS macrosteatosis <30%.

Results: When compared with BT estimations, OS estimations of macrosteatosis were significantly higher (44.49±13.7 vs 16.3± 9.4; P<0.001), with a median 30% (0-70%) overestimation of macrosteatosis and no cases of underestimation. By contrast, there was no significant difference between OS and BT estimations in the standard group (4.8±6.8 vs 3.6±5.3, P=0.08), with a median difference of 0 (10% underestimation – 20% overestimation). Recipients in the FD group had a lower mean Na-MELD score at transplant (17±5.7 vs 19.9±8.4; P=0.02) and higher mean peak AST (2665±2364 vs 1509±2268, p<0.01) and ALT (1312±1016 vs 786±1041, p<0.01) post-transplant. There was no significant difference in patient or graft survival at 1 year when compared with the SD group. The FD group had a significantly higher percentage of donors from national allocation (63.3% vs. 20.5%, p<0.001) and a lower percentage from regional (18.4% vs. 40.4%, p=0.006) and local (18.4% vs 39.1%, p=0.007) allocation. Overall, there was no significant difference in the mean OS and BT estimation of microsteatosis (14.4±21.6 vs 11.0±17.6, p=0.08) with a median difference of 3.2% (range 50% underestimation to 75% overestimation).

Conclusion: On-site estimations of donor macrosteatosis over 30% are often inconsistent with final estimations of macrosteatosis and may have implications for allograft utilization.

CITATION INFORMATION: Wright M., Seal J., De Gregorio L., Bohorquez H., Bruce D., Bugeaud E., Carmody I., Mathur A., Sonnier D., Galliano G., Oliva I., Bratton L., Loss G. Impact of On-Site Overestimation of Macrosteatosis on Donor Liver Biopsy Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress