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

Background On-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. Methods The 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. Results Contrary 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. Conclusions The 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement H.G. is support by the Vitamin Scholarship, Dalhousie University and the Research Nova Scotia Doctoral Award, Research Nova Scotia. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used (or will use) ONLY openly available human data that were originally located at: https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?Cycle=2017-2020 https://optn.transplant.hrsa.gov/data/view-data-reports/request-data/ I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at: https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?Cycle=2017-2020 https://optn.transplant.hrsa.gov/data/view-data-reports/request-data/ * ALT : alanine aminotransferase AST : aspartate aminotransferase BMI : body mass index CAP : controlled attenuation parameter HS : hepatic steatosis IQR : interquartile range IQRc : interquartile range of final controlled attenuation parameter LT : liver transplantation M : medium MaS : macrovesicular steatosis MiS : microvesicular steatosis NHANES : National Health and Nutrition Examination Survey OPTN : Organ Procurement and Transplantation Network SD : standard deviation XL : extra-large