Date: Tuesday, June 5, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Room 3AB
Background & Aims: The growing obesity rate and IV drug use in the USA presage a higher usage of liver allografts with NAFLD or active viral hepatitis in the years to come. Strategies to better assess donor-recipient risk in liver transplants (LT) are thus needed. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) from vibration-controlled transient elastography ([VCTE] Fibroscan, Echosens) are reliable tools to estimate fibrosis and steatosis. We have created a multi-center study to determine their usefulness to predict allograft fibrosis and steatosis in deceased donors. Here, we present results from our initial experience with VCTE performed in donor allografts and their recipients after LT.
Methods: Portable VCTE was performed with Fibroscan-530 before procurement in donation after brain death donors (using M- or XL-probe as appropriate). Recipients underwent VCTE as outpatients 3-6 months after LT. Donor information was obtained from UNOS database.
Results: Out of 35 evaluated donors (33±12 years old, 58% male), 25 recipients have undergone VCTE after a mean follow-up of 4.5±1 months.
|OR Procurement||OP Follow-Up||p|
|LSM (kPa)||6.9 (6.3 -9.9)||5.7 (4.4-8.4)||0.02|
|CAP (dB/m)||231 (174-272)||247 (184-283)||0.41|
|ALT (U/L)||32 (22-66)||22 (18-31)||0.03|
|ALP (U/L)||64 (53-100)||108 (66-145)||0.04|
|Bilirubin (mg/dL)||2.4 (1.8-9.2)||0.7 (0.5-1)||<0.001|
|BMI (kg/m2)||26 (22-28)||26 (23-28)||0.72|
By regression analyses, LSM variability was associated with alkaline phosphatase (β=0.1, p=0.005) and bilirubin (β=0.7, p<0.001), whereas CAP was affected by BMI (β=4.7, p=0.04). In recipient VCTE, the only association was between CAP and BMI (β=8.3, p=0.01). As most donors were on vasopressors (94%), a possible effect on VCTE could not be evaluated.
Discussion: These data represent proof of principle that portable VCTE for LSM and CAP is a promising tool for donor-recipient risk stratification in LT. Moreover, this on-going study suggests a need for new cut-off values for LSM in estimation of fibrosis with possible adjustments for cholestasis and obesity specific to the transplant setting.
CITATION INFORMATION: Duarte-Rojo A., Barone G., Borja-Cacho D., Concepcion W., Shaheen M., Heimbach J., Kim W. Liver Stiffness Measurement, but Not Controlled Attenuation Parameter, is Increased in Deceased Liver Donors at the Time of Transplant Procurement Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Duarte-Rojo A, Barone G, Borja-Cacho D, Concepcion W, Shaheen M, Heimbach J, Kim W. Liver Stiffness Measurement, but Not Controlled Attenuation Parameter, is Increased in Deceased Liver Donors at the Time of Transplant Procurement [abstract]. https://atcmeetingabstracts.com/abstract/liver-stiffness-measurement-but-not-controlled-attenuation-parameter-is-increased-in-deceased-liver-donors-at-the-time-of-transplant-procurement/. Accessed January 18, 2020.
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