Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation
Background. The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is o...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-11-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001540 |
| _version_ | 1827631783362953216 |
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| author | José Sampaio-Neto, MS João E.L. Nicoluzzi, PhD Larissa Luvison Gomes da Silva, PhD Leandro Billó, MS Antônio de Pádua Peppe-Neto, MD Luíza Dall´ Asta, MD Thyago P. de Moraes, PhD Gabrielle R. Fragoso, MD |
| author_facet | José Sampaio-Neto, MS João E.L. Nicoluzzi, PhD Larissa Luvison Gomes da Silva, PhD Leandro Billó, MS Antônio de Pádua Peppe-Neto, MD Luíza Dall´ Asta, MD Thyago P. de Moraes, PhD Gabrielle R. Fragoso, MD |
| author_sort | José Sampaio-Neto, MS |
| collection | DOAJ |
| description | Background. The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns.
Methods. Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated.
Results. Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS.
Conclusions. Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection. |
| first_indexed | 2024-03-09T14:25:55Z |
| format | Article |
| id | doaj.art-8717d062757c4f98bdd437d58a259a23 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-03-09T14:25:55Z |
| publishDate | 2023-11-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-8717d062757c4f98bdd437d58a259a232023-11-28T07:14:05ZengWolters KluwerTransplantation Direct2373-87312023-11-01911e154010.1097/TXD.0000000000001540202311000-00012Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for TransplantationJosé Sampaio-Neto, MS0João E.L. Nicoluzzi, PhD1Larissa Luvison Gomes da Silva, PhD2Leandro Billó, MS3Antônio de Pádua Peppe-Neto, MD4Luíza Dall´ Asta, MD5Thyago P. de Moraes, PhD6Gabrielle R. Fragoso, MD71 School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil.1 School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil.1 School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil.2 Department of Transplantation, Santa Casa de Misericórdia de Curitiba, Curitiba, Paraná, Brazil.2 Department of Transplantation, Santa Casa de Misericórdia de Curitiba, Curitiba, Paraná, Brazil.1 School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil.1 School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil.3 School of Medicine, Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.Background. The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns. Methods. Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated. Results. Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS. Conclusions. Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001540 |
| spellingShingle | José Sampaio-Neto, MS João E.L. Nicoluzzi, PhD Larissa Luvison Gomes da Silva, PhD Leandro Billó, MS Antônio de Pádua Peppe-Neto, MD Luíza Dall´ Asta, MD Thyago P. de Moraes, PhD Gabrielle R. Fragoso, MD Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation Transplantation Direct |
| title | Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation |
| title_full | Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation |
| title_fullStr | Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation |
| title_full_unstemmed | Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation |
| title_short | Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation |
| title_sort | prospective study to analyze the concordance between a standardized visual method with pathology to stratify nonalcoholic fatty liver disease in cadaveric liver grafts evaluated for transplantation |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001540 |
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