Article

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

ABSTRACT

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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    • "It has been shown that the risk of postoperative complications in patients with any degree of steatosis undergoing partial hepatectomy was double that of their non-steatotic counterparts, and that those with severe steatosis had an almost 3-fold increased risk of death [44]. In addition, a study of patients undergoing liver resection for living-related liver donation showed reduced recovery of liver volume over the initial 3 months following surgery in patients with mild steatosis versus no steatosis [45]. "
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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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    ABSTRACT: Early postoperative graft function assessments are essential after living donor liver transplantation (LDLT) to predict patient and graft outcome. Computed tomography (CT) is usually used to evaluate various complications and parenchymal abnormalities after LDLT. Here, we attempted to determine the prognostic values of CT attenuation changes of grafts for predicting 1-year patient survival. Liver attenuation indices (LAIs), derived from differences between hepatic and splenic attenuations, were calculated on unenhanced CT images obtained 10 days after LDLT in 62 adult LDLT recipients between September 2002 and August 2004. Patients were assigned to 1 of 2 groups according to LAI value on the 10th postoperative day, as follows: group L (LAI < or = 5, n = 14) or group H (LAI > 5, n = 48). Parenchymal dysfunction scores, summed parameters for histological dysfunction including both portal tract and centrilobular features, were also assessed on the 10th postoperative day using liver biopsy specimens. Histological parenchymal dysfunction, especially in the centrilobular area, in terms of cholestasis, centrilobular necroinflammation, central vein fibrosis, steatosis, mononuclear infiltrates, and hepatocyte ballooning, was more prominent in group L than in group H, while that in the portal area was similar between the 2 study groups. Significant negative linear correlations were observed between LAI and parenchymal dysfunction scores (r = 0.486, P < 0.001). Group L patients showed lower 1-year survival (69.7%) than group H patients (95.8%; P = 0.0002). Moreover, group H patients died with a functioning graft (n = 3), whereas group L patients died of graft failure (n = 6). After multivariate analysis, LAI alone remained independently associated with 1-year mortality (P = 0.014; odds ratio = 0.845; 95% confidence interval, 0.739-0.967). The sensitivity and specificity of LAI were 84.6% and 75%, respectively, and LAI outperformed MELD score as a predictor of 1-year mortality after LDLT by receiver operating characteristic curve analysis. In conclusion, LAI, as determined by unenhanced CT 10 days after LDLT, well predicts 1-year patient survival after LDLT.
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