Current techniques and future trends in the diagnosis of hepatic steatosis in liver donors: A review

Detecting macrovesicular steatosis (MS) in live and deceased donor livers is crucial. Studies have unequivocally shown that the severity of MS correlates with adverse post-LT outcomes. The degree of MS is intimately related to the viability of the liver graft, which in turn is crucial to the success of the operation. A conventional liver biopsy followed by a formal histological analysis has remained the gold standard for the quantification of hepatic steatosis (HS). However, this technique is invasive and potentially risks several procedure-related complications. Other issues include that of time constraints, availability, and the subjective nature of histological interpretation. To overcome its numerous pitfalls, there is a need to introduce newer modalities and devices to consistently predict the MS of liver allografts. More recently, various novel, non-invasive and reliable techniques of HS quantification based on CT, MRI, ultrasound, and nuclear imaging have come into focus. Various new devices which detect MS based on the physical properties of fat are in different stages of research. This review provides an overview of the currently available methods of quantifying MS, providing evidence-based insights into various innovative technology in the field, appreciating the existing challenges and their future role.