Correlative study of hepatic venous diameter/liver volume index and extent of hepatic steatosis in living related liver donors: a retrospective observational study.

Background Hepatic steatosis is a common incidental finding during pretransplant donor evaluation and a key determinant of graft suitability. During review of donor imaging, we observed that hepatic steatosis was frequently associated with smaller hepatic venous diameters. This study aimed to quantitatively assess the relationship between total hepatic venous diameter and hepatic steatosis and to develop a noninvasive predictive index based on hepatic venous diameter and liver volume.

Methods This retrospective study included 768 prospective liver donors who underwent pretransplant evaluation over 3.5 years. Total hepatic venous diameter (THVD) and total liver volume were measured on computed tomography, and hepatic fat content was quantified using magnetic resonance (MR) proton density fat fraction (PDFF) sequences. We analyzed the correlation between the THVD-to-liver volume ratio (THVD/LV) and hepatic steatosis and evaluated diagnostic performance.

Results Hepatic steatosis (MR-PDFF >6.4%) was present in 22% (169/768) of donors; most had a body mass index of 25.0 to 29.9 kg/m2. A moderate but statistically significant negative correlation was observed between hepatic steatosis and THVD/LV (r=-0.266, P<0.001). For the screening of hepatic steatosis, the THVD/LV index demonstrated an accuracy of 59.5% (95% confidence interval, 55.9%-63.0%), sensitivity of 72.2%, and specificity of 55.9%, with a high negative predictive value (NPV) of 87.7%.

Conclusions The THVD/LV index may serve as a simple, noninvasive parameter for screening hepatic steatosis in living liver donors, given its high NPV. Its application could improve donor-recipient matching and aid preoperative risk assessment for transplant outcomes.