Effect of donor steatosis on liver biochemistry and significance of body mass index and alanine aminotransferase in predicting steatosis

Abstract

BACKGROUND: Hepatic steatosis in living-donor liver transplantation is a major concern on donor safety and graft function. METHODS: Data of 329 Asian donors who underwent right hepatectomy were analyzed. The donors were categorized as having no steatosis (G0, n = 178), <10% steatosis (G1, n = 128), and >10% (G2, n = 19) steatosis. Pattern of change and factors affecting aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and prothrombin time on days 1 to 7 and day 30 were assessed. Factors predicting steatosis were also assessed. RESULTS: A rise in ALT level was noted till day 3 in G1 and day 6 in G2 compared with G0 (p < 0.05). AST levels were different till day 7 in G2 but similar in G1 (p < 0.05). Bilirubin level was higher only in day 1 in G2 (p < 0.05). On multivariate analysis, apart from fatty change, body mass index (BMI) and remnant left lobe volume showed a significant correlation with ALT levels (p < 0.05). By day 30, the median level of enzymes and number of patients having levels above the reference range were similar (p > 0.05). Receiver operating characteristic area under the curve (AOC) for BMI on predicting steatosis was 0.75 (CI = 69–80). Seventy-five percent of patients in the fourth quartile of BMI (23.5–29 kg/m2) had steatosis. Seventy percent of G2 were in this category. In patients with BMI over 23.5 kg/m2, multivariate analysis showed a significant correlation between ALT and steatosis (p = 0.05, OR = 1.14, CI = 1–1.3). ALT level < 17.5 µL predicted steatosis with 66% sensitivity (CI = 52–77) and 78% (CI = 52–92) specificity (AOC -0.71, CI = 56–85). CONCLUSIONS: Donors showed a short-lasting rise in ALT, AST and bilirubin level dependent on the degree of steatosis. For Asian donors, an ALT level above 17.5 µL and a BMI above 23.5 kg/m2 are useful guides in the decision on liver biopsy.