Assessment of hepatic steatosis by transplant surgeon and expert pathologist: A prospective, double-blind evaluation of 201 donor livers

Abstract

An accurate clinical assessment of hepatic steatosis before transplantation is critical for successful outcomes after liver transplantation, especially if a pathologist is not available at the time of procurement. This prospective study investigated the surgeon's accuracy in predicting hepatic steatosis and organ quality in 201 adult donor livers. A steatosis assessment by a blinded expert pathologist served as the reference gold standard. The surgeon's steatosis estimate correlated more strongly with large‐droplet macrovesicular steatosis [ld‐MaS; nonparametric Spearman correlation coefficient (r_S) = 0.504] versus small‐droplet macrovesicular steatosis (sd‐MaS; r_S = 0.398). True microvesicular steatosis was present in only 2 donors (1%). Liver texture criteria (yellowness, absence of scratch marks, and round edges) were mainly associated with ld‐MaS (variance = 0.619) and were less associated with sd‐MaS (variance = 0.264). The prediction of ≥30% ld‐MaS versus Liver Transpl 19:437–449, 2013. © 2013 AASLD.