Dr. Shawl Muzafar
SKIMS College & University, Jammu and Kashmir.
Introduction: Non-alcoholic fatty liver disease (NAFLD) is the hepatic pandemic of the twenty first century. The increasing prevalence of NAFLD in the general population translates directly into an increasing prevalence of NAFLD in both, potential deceased and live liver donors. Graft steatosis, in turn, affects both, the quality and the quantity of donor livers available for transplantation. The development of primary dysfunction, early allograft dysfunction, poor overall graft survival, and other complications have been reported in recipients of steatotic grafts in liver transplantation.
Methods: A total of 124 prospective liver donors over a period from June 2014 to March 2016 from Apollo hospital Delhi were included in this study. The demographics, findings on general physical and systemic examination, anthropometric measures results of blood investigations done as part of donor work up, radiological investigations and liver biopsy findings were noted.
Results: Out of 124 study participants 73 (59%) were male and 51 (49%) were female. Mean age of participants was 31.71 years. Prevalence of fatty liver was 23% on USG abdomen, 31% On CT Liver Attenuation Index (LAI), 49% on MRS. High BMI (>25kg/m2), increased WC and WHR were significantly associated with presence of fatty liver. USG abdomen in comparison to CT LAI had sensitivity 55%, Specificity 91%, PPV 72%, NPV 82% and accuracy of 80% in diagnosing fatty liver. Similar values for CT LAI in comparison to MRS were 57%, 95%, 92%, 70% and 77% respectively and for USG abdomen in comparison to MRS the values were 43%, 95%, 96%, 63%, 69%. For MRS versus liver biopsy similar values were 100%, 33%, 92%, 100% and 92% respectively.
Conclusion: NAFLD epidemic is directly translating into higher prevalence of fatty liver among prospective liver donors. MRS is emerging as a useful test to quantify hepatic fat, comparable to liver biopsy.
Key Words: Non-Alcoholic Fatty Liver Disease (NAFLD), Liver Attenuation Index (LAI), Magnetic Resonance Spectroscopy