Is liver biopsy necessary in the evaluation of a living donor for liver transplantation?

Is it Possible to Avoid Liver Biopsy in Living Donors for Liver Transplantation by Using Two-Dimensional Shear Wave Elastography?

PURPOSE

The present study aims to evaluate the correlation of two-dimensional shear wave elastography results with histopathological findings performed simultaneously with liver biopsy (LB) in healthy liver transplant donors.

METHODS

A total of 53 living donors, 35 male and 18 female, were included in this prospective, observational, single-center study. Patients with abnormal liver function tests were not included in our study. Hepatosteatosis, fibrosis, and inflammation were evaluated with the Fatty Liver Inhibition of Progression and Steatosis, Activity, and Fibrosis algorithm of donor LB.

RESULTS

The mean age of the donors was 33.04 ± 9.07 years and the mean body mass index was 23.41 ± 6.23 kg/m². The mean elastography kilo pascal (kPA) value of all donors was determined as 6.03 ± 2.32 kPa. The mean LB activity scores of the donors were found to be 1.64 ± 1.18 and ranged from 0 to 5. There was no significant correlation between elastography kPa value and pathologic activity score, steatosis score, balloon degeneration, and inflammation grade fibrosis scores (P > .05).

CONCLUSION

Shear wave elastography measurements showed that the predictive power of pathologic findings in donor LB was not sufficient.

High-resolution MR imaging with gadoxetate disodium for the comprehensive evaluation of potential living liver donors

OBJECTIVE

Several major transplantation centers have used composite multimodality evaluation for the preoperative evaluation of potential living liver donors. This approach can be time-consuming and, although rare, can cause complications. We aimed to demonstrate the clinical feasibility of our comprehensive preoperative MR protocol for the preoperative assessment of living liver donor candidates instead of composite multimodality evaluation.

MATERIALS AND METHODS

Thirty-five consecutive living liver donor candidates underwent multiphasic liver CT and comprehensive donor protocol MR examinations for preoperative evaluation in a single large-volume liver transplantation (LT) center. Three blinded abdominal radiologists reviewed the CT and MR images for vascular and biliary variations. The strength of agreement between CT and MR angiography was assessed using the kappa index. The detection rate of biliary anatomical variations was calculated. The sensitivity and specificity for detecting significant steatosis (>5%) were calculated. The estimated total volume and right lobe volumes measured by MR volumetry were compared with the corresponding CT volumetry measurements using the intraclass correlation coefficient (ICC).

RESULTS

Among the 35 patients, 26 underwent LT. The measurement of agreement showed a moderate to substantial agreement between CT and MR angiography interpretations (kappa values, 0.47-0.79; p < 0.001). Combining T2-weighted and T1-weighted MR cholangiography techniques detected all biliary anatomical variations in 9 of the 26 patients. MR-proton density fat fraction showed a sensitivity of 100% (3/3) and a specificity of 91.3% (21/23) for detecting pathologically determined steatosis (>5%). MR volumetry reached an excellent agreement with CT volumetry (reviewers 1 and 2: ICC, 0.92; 95% CI, 0.84-0.96).

CONCLUSION

Our one-stop comprehensive liver donor MR imaging protocol can provide complete information regarding hepatic vascular and biliary anatomies, hepatic parenchymal quality, and liver volume for living liver donor candidates and can replace composite multimodality evaluation.

Living donor liver transplantation in Europe

Living donor liver transplantation (LDLT) sparked significant interest in Europe when the first reports of its success from USA and Asia were made public. Many transplant programs initiated LDLT and some of them especially in Germany and Belgium became a point of reference for many patients and important contributors to the advancement of the field. After the initial enthusiasm, most of the European programs stopped performing LDLT and today the overall European activity is concentrated in a few centers and the number of living donor liver transplants is only a single digit fraction of the overall number of liver transplants performed. In this paper we analyse the present European activities and highlight the European contribution to the advancement of the field of LDLT.