Liver discard rate due to conservative estimations of steatosis: an inference-based approach

BackgroundOn-site conservative estimations of steatosis could result in the unnecessary discard of donor livers. This study applied the body mass index (BMI) as an independent statistical indicator to determine the extent of this problem. We explored two hypotheses: (I) that because of varying levels of expertise and protocols (reputational risk for pathologists), biopsies at transplant centers overestimate hepatic steatosis (HS), and (ii) that non-biopsy donor liver assessments are more conservative than biopsy-based evaluations. MethodsThe study processed cross-database and intra-database comparisons using data from the National Health and Nutrition Examination Survey (NHANES) and Organ Procurement and Transplantation Network (OPTN) spanning January 2017 to March 2020 in the United States. Post-matching BMI was applied as an independent indicator of statistical risk of HS. ResultsContrary to our first hypothesis, biopsies at transplant centers did not overestimate HS - biopsy-classified donor livers were found in similar or lower risk categories. Consistent with our second hypothesis, absent biopsies, evaluations before and during organ procurement were observed to be more conservative, leading to the discard of 11.9% (373) of potential donor livers. ConclusionsThe study concludes that there was a significant (11.9%) disparity caused by on-site non-biopsy assessments of HS, leading to the unnecessary discard of potential donor livers. The findings emphasize the need to develop more accurate intraoperative techniques for assessing HS to optimize donor liver procurement.