Mild hepatic steatosis is not a major risk factor for hepatectomy and regenerative power is not impaired

Department of Surgery, Seoul National University, Sŏul, Seoul, South Korea
Surgery (Impact Factor: 3.38). 05/2006; 139(4):508-15. DOI: 10.1016/j.surg.2005.09.007
Source: PubMed


An understanding of the regeneration power and operative risk of steatotic livers after hepatectomy is still unclear. We evaluated the volume regeneration and outcome of steatotic livers after donor hepatectomy.
Fifty-four, consecutive living liver donors from September 2002 to December 2003 were evaluated prospectively by volumetric analysis, liver-spleen ratio, and liver attenuation index; the latter has been shown by serial computed tomographic scanning to be correlated strongly with histologic steatosis. Donors were followed up completely for at least 1 year (460-915 days) and were allocated according to histologic degree of macrovesicular steatosis: group 1, <5% (n = 36); group 2, 5%-30% (n = 18).
No mortality or hepatic failure was observed, and no donor required reoperation or intraoperative transfusion. The results of serial liver function tests, and major and minor morbidities were comparable between groups. Liver-spleen ratio and liver attenuation index remained at a constant level above normal values postoperatively in group 1, but increased rapidly above normal values in group 2. No difference in the rate of liver regeneration at 10 days after hepatectomy was found between the groups (P = .487), but the liver regeneration rate at 3 months after hepatectomy in group 1 was slightly higher than that in group 2 (P < .044). However, no difference was observed between the 2 groups at 1 year after hepatectomy (P = .4).
Mild hepatic steatosis is cleared immediately after hepatectomy, and early regeneration power is impaired, but the long-term regenerative power is comparable. Hepatectomy in donors with mild steatosis can be performed with low morbidity.

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    • "While these results are valid for deceased donor liver transplantation , the experience of using fatty liver grafts for living donor liver transplantation is scarce and hepatic steatosis is usually regarded as a contraindication for living donation in most centers [48]. However, the regeneration ability of the fatty liver is controversially discussed [49] [50]. Whether potential donors with mild steatosis should be completely denied from live donation depends, therefore, also on graft volume and donor age. "
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