Validating controlled attenuation parameter in the assessment of hepatic steatosis in living liver donors

Influence of age, body mass index and gender on sonographic indicators of the liver in patients with metabolic dysfunction-associated steatotic liver disease

Background. The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing along with the increasing prevalence of obesity. There are close relationships between these two pathologies due to the functioning of adipose tissue as an endocrine organ with a complex influence on various metabolic processes. It is known that premenopausal women are less prone to fatty liver disease than men. The aim was to study the influence of gender, body mass index (BMI) and age on sonographic indicators and the degree of liver steatosis in patients with metabolic dysfunction-associated steatotic liver disease. Materials and methods. Ninety-two patients with MASLD were included in the study, 48 women and 44 men. Inclusion criterion was metabolic dysfunction-associated steatotic liver disease, exclusion criteria were any non-metabolic factors of chronic diffuse liver disease. Patients were divided into groups by gender and age. Women were divided by age according to the presence and absence of menopause, men were divided into groups below and above 45 years — the conventional age of the beginning of the decline in gonadotropic function. The analysis of structural changes of the liver, namely the assessment of the size, contours, structure, echogenicity, and visualization of blood vessels in the B-mode was carried out with the help of ultrasound examination on Toshiba Xario 660 (Japan). The degree of steatosis was assessed by the controlled attenuation parameter. Results. In men, the right, left and caudate liver lobes were significantly larger (p < 0.05) than in women, which is due to the higher weight of men in the absence of a difference in the BMI. There was no significant difference between men and women in degree of steatosis (p > 0.05). A moderate positive correlation (r = 0.63) was found between BMI and the controlled attenuation parameter; in women, there was no connection between these indicators. Analysis of correlations in women of different ages, divided by the presence of menopause, found that before menopause, there was no dependence of steatosis indicators on BMI, while with the onset of menopause, the coefficient of correlation between these indicators was 0.39 (р < 0.02). Conclusions. No significant difference was found between the frequency of various degrees of steatosis in MASLD according to the controlled attenuation parameter in men and women. There was a dependence of the severity of liver steatosis on the BMI in men, the dependence of steatosis on the body mass index in women was manifested starting from the menopause period, which suggests the protective role of female sex hormones.

Current Understanding of Marginal Grafts in Liver Transplantation

End-stage liver disease (ESLD), stemming from a spectrum of chronic liver pathologies including chronic liver failure, acute cirrhosis decompensation and hepatocellular carcinoma, imposes a significant global healthcare burden. Liver transplantation (LT) remains the only treatment for ESLD. However, the escalating mortality on transplant waitlists has prompted the utilization of marginal liver grafts in LT procedures. These grafts primarily encompass elderly livers, steatotic livers, livers from donation after circulatory death, split livers and those infected with the hepatitis virus. While the expansion of the donor pool offers promise, it also introduces concomitant risks. These encompass graft failure, biliary and cardiovascular complications, the recurrence of liver disease and reduced patient and graft survival. Consequently, various established strategies, ranging from improved donor-recipient matching to surgical interventions, have emerged to mitigate these risks. This article undertakes a comprehensive assessment of the current landscape, evaluating the viability of diverse marginal liver grafts. Additionally, it synthesizes approaches aimed at enhancing the quality of such marginal liver grafts. The overarching objective is to augment the donor pool and ameliorate the risk factors associated with the shortage of liver grafts.

Characterization of hepatic steatosis using controlled attenuation parameter and MRI-derived proton density fat fraction in living donor liver transplantation

BACKGROUND

The increasingly favorable outcomes of live donor liver transplant warrant development of screening techniques to expand current donor pool. Transient elastography (TE) with controlled attenuation parameter (CAP) is accessible and has promising diagnostic performance in non-obese individuals. Here, we demonstrate its utility in grading donor steatosis for risk assessment in living liver donors (LLD).

STUDY DESIGN

In a prospective study of LLD and recipients, accuracy was determined using MRI-derived proton density fat fraction (PDFF) as reference.

RESULTS

One hundred and one LLD underwent TE, 95 of whom had available PDFF. Median CAP and MRI-PDFF were 233 dB/m (206-270) and 2.9% (2.3-4.0), respectively. A CAP threshold of 270 dB/m captured all steatosis which was present in 13 (13%) LLD (AUROC .942, 100% sensitivity and 83% specificity). Performance further improved when excluding obese LLD and limiting analysis to M-probe (AUROC .971 and .974, respectively, with 87% specificity). There was no difference in CAP and MRI-PDFF between LLD and nondonors (P = .26 and .21, respectively). Early allograft dysfunction was observed in one recipient (CAP 316, PDFF 9.5%), zero underwent retransplant, and one died from sepsis.

CONCLUSION

The specific role of CAP in living liver donation warrants further study, beginning with its use as screening tool across peripheral clinics.

Diagnostic accuracy of ultrasound-guided attenuation parameter as a noninvasive test for steatosis in non-alcoholic fatty liver disease

The purpose of this study was to evaluate the diagnostic accuracy of the ultrasound-guided attenuation parameter (UGAP) using the LOGEQ E10 for hepatic steatosis in non-alcoholic fatty liver disease (NAFLD) patients and directly compare UGAP with attenuation imaging (ATI) and controlled attenuation parameter (CAP). We prospectively analyzed 105 consecutive patients with NAFLD who underwent UGAP, ATI, CAP, and liver biopsy on the same day between October 2019 and April 2021. The diagnostic ability of the UGAP-determined attenuation coefficient (AC) was evaluated using receiver operating characteristic (ROC) curve analysis, and its correlation with ATI-determined AC values or CAP values was investigated. The success rate of UGAP was 100%. The median IQR/med obtained by UGAP was 4.0%, which was lower than that of ATI and CAP (P < 0.0001). The median ACs obtained by UGAP for grades S0 (control), S1, S2, and S3 were 0.590, 0.670, 0.750, and 0.845 dB/cm/MHz, respectively, demonstrating a stepwise increase with increasing hepatic steatosis severity (P < 0.0001). The areas under the ROC curve of UGAP for identifying ≥ S1, ≥ S2, and S3 were 0.890, 0.906, and 0.912, respectively, which were significantly better than the results obtained with CAP for identifying S3. Furthermore, the correlation coefficient between UGAP-AC and ATI-AC values was 0.803 (P < 0.0001), indicating a strong relationship. Our results indicate that UGAP has high diagnostic accuracy for detecting and grading hepatic steatosis in patients with NAFLD.