Comparison of Histological Analysis and Gross Assessment for Detection of Donor Liver Macrovesicular Steatosis in Liver Transplantation: A Systematic Review and Meta-Analysis.

Abstract

Background: Conflicting information exists regarding the impact of different detection methods for macrovesicular steatosis (MaS) in liver transplantation (LT). Therefore, the two MaS estimation methods, histological analysis and gross examination, and their influence on LT were compared.

Methods: We included all studies describing allograft steatosis in adult deceased donor's LT. The outcome was evaluated either by histological analysis or macroscopic assessment by the surgeon.

Results: Of the 3483 studies, 21 were eligible and included in our analysis (3155 participants). In the histological analysis detection method, the results showed a significantly higher graft loss at 1-year follow-up (odds ratio [OR] 1.61, P = .01), 3-year (OR 1.45, P = .05), and 5-year (OR 1.65, P = .01) in the moderate/severe MaS patients following transplantation. In the gross examination method, all results were statistically insignificant. The meta-regression, adjusting for the detection method, suggests a significant association between the histological method and increased graft loss compared to the gross method.

Conclusions: Our data demonstrate that the patients evaluated through the histological method tend to have reliable outcomes to those evaluated through gross examination. Therefore, it may be crucial to use precise donor steatosis evaluation using the histological method.