Sonographic Hepatosplenic Ratio: A Noninvasive Method to Diagnose Graft Steatosis in Liver Transplantation

Liver steatosis is considered one of the most common disorders. Macrovesicular steatosis in donor livers is a major cause of graft failure and remains difficult to assess. The aim of this study is to evaluate the correlation between the hepato-splenic ratio (HSR) obtained by back table ultrasound (US) and the histological grade of graft steatosis, using liver biopsy as a reference. Between October 2019 and December 2021, 50 cadaveric liver transplant donors were studied. Back-table US was used to determine the HSR, which is obtained by dividing the mean brightness level of the liver region of interest by that of the splenic region. Biopsy was performed in all donors and fixed in 4% formalin. The histological variables analyzed were steatosis, fibrosis and inflammatory infiltrate. Spearman's coefficient was used to assess the correlation between the HSR and the presence of macrovesicular hepatic steatosis (r 0.28, P < .05). The cut-off of hepato-splenic ratio to predict steatosis is 0.91 (sensitivity 75% and specificity 57%). The mean ± SD of the ratio in the control and steatosis group were 0.9 ± 0.14 and 1.03 ± 0.3 (P = .11), respectively. The HSR can be a simple, objective and noninvasive method to assess the quality of the liver, which can be used in some contexts of liver procurement, when second-level imaging is not available or when liver biopsy is not possible.