Body Mass Index and Unenhanced CT as a Predictor of Hepatic Steatosis in Potential Liver Donors

Background. In living-donor liver transplantation, donor hepatic steatosis is crucial for both the donor and the recipient. Body mass index (BMI) and the unenhanced computed tomography liver attenuation index (CT LAI) are noninvasive methods to predict hepatic steatosis in living-donor liver candidates. Aim. To analyze the diagnostic accuracy of CT LAI in conjunction with different BMI values for macrovesicular steatosis in living-donor liver candidates. Methods. A total of 264 potential liver donors were included. The diagnostic accuracy of 2 CT LAI cut-offs and 3 BMI cut-off values for the assessment of hepatic steatosis >= 15% and <= 5% was determined. Results. Using CT LAI, the area under the receiver operating characteristic curve was 0.97 (95% CI = 0.89-0.99) for hepatic steatosis >= 15% in donors with BMI <25 kg/m(2). For detecting hepatic steatosis >= 15%, a CT LAI <= 0 had specificities of 100%, 76.2%, and 55.6% and positive predictive values of 100%, 95.5%, and 93.5% for patients with BMI values <25 kg/m(2), 25 to 29.9 kg/m(2), and >= 30 kg/m(2), respectively. According to logistic regression analyses, only CT LAI <= 0 was found to be independently associated with hepatic steatosis >= 15%. Conclusions. In donors with BMI <30 kg/m(2) and a CT LAI value >6, liver biopsy might be avoided. Biopsy may be reserved solely for donors with CT LAI value >0 and BMI >= 30 kg/m(2) as the diagnostic accuracy of computed tomography for predicting hepatic steatosis decreases with increasing BMI.