Predictors of hepatic steatosis in living liver donors

M. Minina, D. Voronov, A. A. Nevredimov, E. A. Tenchurina
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Abstract

Fatty liver disease (steatosis) is considered a risk factor in donor liver transplantation (LT). Macrosteatosis (>50%) is associated with primary graft dysfunction and may reduce long-term recipient survival.Objective: to identify predictors of macrovesicular steatosis (>50%) by analyzing donor characteristics.Materials and methods. The retrospective study included 525 potential liver donors between January 1, 2019 and December 31, 2020. Clinical and morphological characteristics of donors were studied using logistic regression and receiver operating characteristic (ROC) analysis. Threshold values of parameters demonstrating statistical significance in multivariate analysis as predictors of >50% hepatic steatosis were obtained by ROC analysis based on calculation of the optimal cutoff point.Results. Diabetes mellitus (DM), cause of donor’s death (traumatic brain injury), alanine transaminase (ALT) >90 units/L and aspartate transaminase (AST) >110 units/L were predictors of >50% steatosis, revealed by time-zero biopsy in the donor. Almost identical sensitivity and specificity indicators were determined in ROC analysis for liver enzymes – ALT and AST – which were 69.1 and 80.6; 72.2 and 81.1, respectively. Given the obtained values, we can say that with elevated levels of liver enzymes in the donor’s blood, there is a high degree of probability of liver parenchymal damage, but low sensitivity indicates possible multifactoriality of liver damage, and fatty liver disease may be one of the factors, but there may also be no damage to the liver parenchyma. At the same time, the rather high specificity revealed in ROC analysis for liver enzymes is a reliable sign of the absence of fatty liver disease at enzyme values less than the threshold.Conclusion. The thresholds established for ALT and AST and their corresponding levels of sensitivity and specificity indicate that these parameters have a relatively low predictive level in the context of the presence of severe fatty liver disease in a donor. This allows, nevertheless, to use models built on their basis as screening models in the primary evaluation of liver donors.
活体肝供者肝脂肪变性的预测因素
脂肪肝疾病(脂肪变性)被认为是供肝移植(LT)的危险因素。大脂肪变性(>50%)与原发性移植物功能障碍有关,并可能降低受体的长期生存率。目的:通过分析供体特征,确定大泡性脂肪变性(>50%)的预测因素。材料和方法。这项回顾性研究包括2019年1月1日至2020年12月31日期间的525名潜在肝脏捐赠者。采用logistic回归和受者工作特征(ROC)分析研究供者的临床和形态学特征。在计算最佳截止点的基础上,通过ROC分析获得在多变量分析中具有统计学意义的参数阈值作为>50%肝脂肪变性的预测因子。供体零时间活检显示,糖尿病(DM)、供体死亡原因(外伤性脑损伤)、谷丙转氨酶(ALT) >90单位/L、天冬氨酸转氨酶(AST) >110单位/L是供体脂肪变性>50%的预测因素。在ROC分析中,肝酶(ALT和AST)的敏感性和特异性指标几乎相同,分别为69.1和80.6;分别为72.2和81.1。根据所获得的数值,我们可以说,供者血液中肝酶水平升高,肝实质损害的概率很高,但低敏感性提示肝损害可能是多因素的,脂肪肝疾病可能是其中一个因素,但也可能没有肝实质损害。同时,ROC分析显示肝酶具有较高的特异性,这是在酶值低于阈值时不存在脂肪肝的可靠标志。ALT和AST的阈值及其相应的敏感性和特异性水平表明,这些参数在供者存在严重脂肪肝的情况下具有相对较低的预测水平。然而,这允许使用在其基础上建立的模型作为筛选模型,用于肝供者的初步评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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