Liver biopsy findings from healthy potential living liver donors: Reasons for disqualification, silent diseases and correlation with liver injury tests

• Published in: Journal of hepatology 2009-03, Vol.50 (3), p.501-510
• Main Authors: Minervini, Marta I, Ruppert, Kristine, Fontes, Paulo, Volpes, Riccardo, Vizzini, Giovanni, de Vera, Michael E, Gruttadauria, Salvatore, Miraglia, Roberto, Pipitone, Loredana, Marsh, J. Wallis, Marcos, Amadeo, Gridelli, Bruno, Demetris, Anthony J
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Biopsy - methods; Body Mass Index; Continental Population Groups; Digestive system; Ethnic Groups; Fatty Liver - epidemiology; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver - injuries; Liver - pathology; Liver Diseases - epidemiology; Liver injury tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Living donor liver biopsy; Living Donors; Male; Medical sciences; Multivariate Analysis; Non-alcoholic fatty liver disease; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patient Selection; Reference Values; Retrospective Studies; Risk Factors; Steatohepatitis; Transplantation
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2008.10.030

Background/Aims Liver biopsies detect silent donor disease in potential living liver donors and provide material for studies of subclinical non-alcoholic fatty liver disease (NAFLD). Our primary goal was to determine the contribution of biopsy findings to potential donor evaluation. Factors contributing to pre-clinical NAFLD and correlations between liver injury tests and histopathology have been also determined. Methods Patient records, laboratory tests and results of the histopathologic examination and diagnoses of 284 patients from 2001 to 2005 were retrospectively extracted from the EDIT database. Hepatic histology was correlated with liver injury tests and with general demographic characteristics in an otherwise normal healthy population. Results A minority ( n = 119; 42%) of biopsies from this population of 143 males/141 females (average age = 36.8 years; mean BMI = 26.6) were completely normal. The remainder showed steatosis ( n = 107; 37%), steatohepatitis ( n = 44; 15%), or unexplained low-grade/early stage chronic hepatitis, primary biliary cirrhosis, or nodular regenerative hyperplasia ( n = 16; 6%). Biopsy findings disqualified 29/56 donors. Independent risk factors for NAFLD by multivariate modeling, which differed by sex, included: BMI ( p = 0.0001), age ( p = 0.003), iron ( p = 0.01), and ALT ( p = 0.004). Conclusions Liver biopsies provide valuable information about otherwise undetectable liver disease in potential liver donors. Obesity, age and iron, which are influenced by sex, contribute to NAFLD pathogenesis. Blood tests other than standard liver profiles are needed to detect early NAFLD.