Threshold-based association between controlled attenuation parameter-defined hepatic steatosis and hepatectomy-associated ischemia-reperfusion injury: A retrospective cohort study.

ObjectiveFatty liver is known to aggravate hepatic ischemia-reperfusion injury; however, the relationship between the preoperative controlled attenuation parameter measured by transient elastography and ischemia-reperfusion injury after hepatectomy has not been fully clarified. This study aimedt to explore the association between controlled attenuation parameter-defined hepatic steatosis and hepatic ischemia-reperfusion injury after hepatectomy.MethodsIn this single-center retrospective study, 1461 patients who underwent hepatectomy between 2022 and 2024 were included and stratified into four groups according to controlled attenuation parameter-based steatosis grades. The primary endpoints were peak alanine aminotransferase and aspartate aminotransferase levels within 3 days after surgery. Secondary endpoints comprised additional postoperative laboratory indices and short-term clinical outcomes, including complications and mortality. Data were analyzed using multivariable linear regression, restricted cubic spline modeling to explore nonlinear associations, and propensity score matching to compare patients with grade 3 and grade 0 steatosis.ResultsCompared with the nonsteatotic group, only patients with severe fatty liver (controlled attenuation parameter > 292 dB/m) exhibited significantly higher postoperative alanine aminotransferase and aspartate aminotransferase levels. However, restricted cubic spline analysis did not demonstrate a significant positive dose-response relationship between controlled attenuation parameter and liver enzyme levels. In multivariable models, severe fatty liver was independently associated with elevated peak alanine aminotransferase, whereas no consistent association was observed for aspartate aminotransferase. After propensity score matching, severe steatosis remained associated with higher alanine aminotransferase, without significant differences in aspartate aminotransferase or major short-term clinical outcomes.ConclusionsPreoperative controlled attenuation parameter assessment is most valuable for identifying patients with severe hepatic steatosis, who appear more susceptible to aggravated ischemia-reperfusion injury after hepatectomy, rather than for predicting ischemia-reperfusion injury severity across the full controlled attenuation parameter spectrum.