Liver Discard Rate Attributable to Conservative Estimations of Steatosis: An Inference-based Approach

Area of Science:

• Transplantation research
• Hepatology
• Medical diagnostics

Background:

• On-site estimations of liver steatosis can lead to unnecessary donor liver discards.
• Body mass index (BMI) was used as a statistical indicator to assess the extent of this issue.
• The study aimed to compare the conservativeness of nonbiopsy versus biopsy-based donor liver assessments.

Purpose of the Study:

• To quantitatively evaluate if nonbiopsy donor liver assessments are more conservative than biopsy-based evaluations.
• To determine the rate of unnecessary donor liver discards due to on-site assessments.
• To highlight the impact of body mass index on hepatic steatosis risk assessment.

Main Methods:

• Intradatabase comparisons of 177,081 donor records from the Organ Procurement and Transplantation Network (2004-2022).
• Body mass index was utilized as an independent statistical indicator for hepatic steatosis (HS) risk.
• Matched pairs of donors with and without biopsy records were analyzed across different time periods.

Main Results:

• A significant percentage of potential donor livers were discarded due to nonbiopsy assessments: 16.4% (2004-2010), 16.9% (2011-2014), 10.6% (2015-2018), and 10.3% (2019-2022).
• These discard rates were consistently higher in cases lacking biopsy records, supporting the hypothesis of more conservative evaluations.
• The study identified a disparity in donor liver utilization based on assessment methods.

Conclusions:

• On-site, nonbiopsy assessments for hepatic steatosis (HS) cause a significant disparity, leading to unnecessary donor liver discards (10.3%-16.9%).
• The findings underscore the need for improved intraoperative techniques for HS assessment.
• Optimizing donor liver procurement requires more accurate methods to evaluate fatty liver disease.