1037 MRI does not accurately predict fat in evaluation for living donor liver transplantation

HEPATOLOGY, Vol. 38, No. 4, Suppl. 1, 2003

AASLD ABSTRACTS

1037 MRI DOES NOT ACCURATELY PREDICT FAT IN EVALUATION FOR LIVING DONOR LIVER TRANSPLANTATION. Tram T Tran, Steven Colquhoun, Nicholas

Nissen, Paul Martin, Rola Saouaf, Linda Hwa, Chanikarn Changsri, Fred Poordad, Stephen A Geller, John M Vierling, Christopher Shackleton, Cedars-Sinai Medical Center, Los Angeles, CA Background:Significant steatosis, generally defined as >30% of the hepatic parenchyma, has b e e n associated with primary nonfunction of a transplanted cadaveric graft, and has been shown to impair liver regeneration in animal models. Quantifying the amount of steatosis in potential donors for living donor liver transplantation (LDLT) is therefore important in donor selection. We previously reported that liver biopsy detected unsuspected histopathology in 73% of donor candidates, including predominant steatosis in 30%. Since MRI provides a semiquantitative estimate of hepatic steatosis, we sought to determine if this noninvasive test accurately predicted steatosis. Aim: To compare histologic and MRI assessment of steatosis in donor candidates for LDLT. Methods: 48 donor candidates (19F, 29M) undergoing evaluation for adult-to-adult or adult-to-child living donor liver transplant had MRI performed with 1.5T magnet, TR90-150, in-phase TE 4.2-4.8 and out-of-phase TE 1.8-2.4. Two radiologists blinded to histologic findings and clinical history assessed each MRI.Two pathologists, blinded per protocol assessed each biopsy. In 11/48 the MRI protocol performed at that time had gradient echo sequences with varying TR and TE. The remaining 37/48 had MRI protocol using only variable TE. Results: Among the donor candidates 21/48 (44%) had steatosis on liver biopsy. The average BMI was 25.6 kg/m 2. 7/21 (33%) of donors with steatosis on biopsy had no evidence of fat on MRI. The majority of those with unrecognized steatosis on MRI had grade I steatosis (<30%), however one case had >30% steatosis. In 6 patients with higher grades of steatosis (2 or 3), MRI also underestimated quantity of fat (TABLE 2). Conclusions: MRI failed to detect biopsy-proven steatosis in 33% of potential donor candidates for living donor liver transplantation. MRI seriously underestimated the amount of steatosis in those with >30% steatosis, which can negatively impact outcome of both the donor and recipient in living donor liver transplantation. These findings support the use of liver biopsy in the evaluation of potential donors for living donor liver transplantation.

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1038 SPLIT LIVER TRANSPLANTATION: SINGLE CENTER EXPERIENCE. Sukru H~ mre, Tarik Artis, Gabriel Gondolesi,

Sander Florman, Sasan Roayaie, Krieger Nancy, Benjamin Shneider, Thomas Fishbein, Myron Schwartz, Charles Miller, Mount Sinai School of Medicine, New York, N Y Split liver transplantation (SLT) is an innovative technique to increase the number of donor livers. It is our policy to split every suitable liver to provide allografts for 2 recipients. We report our experience with SLT comparing outcomes of ex vivo and in situ grafts. Methods: Between 2/94-1/03, 31 livers were split to provide 62 (43 ex vivo and 19 in situ) allografts. On 22 occasions, ex vivo splitting was performed on the back table and 10 livers were split in situ; 2 livers were shared with other centers. Results: Twentyfour adults (mean age, 50.95±13.22 yr It, 22-68]) and 38 children (mean age, 3.66±4.58 yr It, lmos-15yr]) received split grafts. Right lobe grafts were placed in 23 adults and 6 child;1 left lobe graft was used for a child, left lateral segment grafts were received to 31 children and 1 adult. Twentyfive livers were shared by adult-child pairs, 1 liver was shared by 2 adults, 5 livers were shared by 2 children. Seventeen patients were UNOS status 1, 29 were UNOS status 2, and 16 were UNOS status 3. Total ischemia time (TIT) was 637±181,34 min for the ex vivo SLT vs 588±229,41 rain for in situ SLT ( p - n s ) . Incidences of overall surgical complications were not significant.Four (6.4%) primary non-function (PNF) occurred overall 3 (6.9%) in ex vivo SLT vs I (5.2%) in in situ SLT. Hepatic artery thrombosis occurred in only I of the adult patients who received in situ right lobe graft, overall (1.6%). Two children recieving ex vivo left lateral grafts had portal vein thrombosis, overall (3.2%), Biliary complications occurred in 5 (11.6%) ex vivo SLT vs 1 (5.2%) in the in situ SLT. Eight patients (12.9%) had retransplants overall, 6 (13.9%) from ex vivo SLT vs 2 (10.5%) from in situ SLT. One- and 5-yr actual graft survival rates of overall, ex vivo and in situ SLT were 84.1% and 63.6%, 80.3% and 64%, 93.7% and 56.2%, respectively. One- and 5-yr actual patient survival rates were 87.7% and 75.7%, 85.3% and 71.9%, 94.1% and 94.1%, respectively. Conclusions: These encouraging results ,which represent the experience of a single center over 9 years, suggest that SLT can be performed with good overall outcome and all suitable livers should be considered for splitting. Disclosures: Tarik Artis - No relationships to disclose Sukru H Emre - No relationships to disclose Thomas Fishbein No relationships to disclose Sander Florman - No relationships to disclose Gabriel Gondolesi - No relationships to disclose Charles Miller - No relationships to disclose Krieger Nancy - No relationships to disclose Sasan Roayaie - No relationships to disclose Myron Schwartz - No relationships to disclose Benjamin Shneider - No relationships to disclose -

Disclosures: Chanikarn Changsri - No relationships to disclose Steven Colquhoun - No relationships to disclose Stephen A Geller - No relationships to disclose Linda Hwa - No relationships to disclose Paul Martin - No relationships to disclose Nicholas Nissen - No relationships to disclose Fred Poordad - No relationships to disclose Rola Saouaf - No relationships to disclose Christopher Shackleton - No relationships to disclose Tram T Tran - No relationships to disclose John M Vierling - No relationships to disclose