Outcome of Living-Donor Liver Transplantation Using Grafts from Donors Treated for Fatty Liver

Abstract

The aim of this study was to determine the efficacy of treating donors' fatty liver (FL) and to assess early graft function in recipients who received treated FL grafts in living-donor liver transplantation (LDLT). Material/Methods:Data were collected for adult-to-adult LDLTs. Donors diagnosed with FL (FL group) received diet-exercise and pharmacological treatment. The perioperative findings and early transplanted graft function were compared with those of donors without FL (non-FL group) during the same period. Results:Of 30 donors, 8 were determined to have FL. The median duration of treatment for FL was 58 days. The liver-tospleen attenuation ratios on CT scan in the FL group were significantly improved after treatment: 0.95 (0.62-1.06) to 1.2 (1.12-1.46) (P=0.003). Liver biopsy prior to donor surgery showed £10% fatty infiltration. Postoperative laboratory findings of the donors in the FL group were comparable to those in the non-FL group: maximum alanine transaminase (189.6±94.7 IU/L vs. 196.8±57.4) and maximum total bilirubin (2.2±1.1 mg/dL vs. 1.7±0.5 mg/dL). No major complications were observed after donor hepatectomy in either group. There were no significant differences between the 2 groups in early graft function, as evaluated by laboratory data, ascites volume, and bile production 2 weeks postoperatively. Graft and patient survival were 100% in both groups at 3 months. Conclusions:Preoperative intentional treatment for FL was effective. Early graft function and donor postoperative course were comparable in the 2 groups. These results suggest that well-treated steatotic grafts can be used without jeopardizing donor safety.

Defatting strategies in the current era of liver steatosis

“…Overall, the study demonstrated that steatosis reduction is feasible albeit several weeks which in some instances may not be possible due to the recipient's health. Similar results were also found by Fujii and colleagues (57). In this study, potential donors diagnosed with fatty liver via computerized tomography scan were prescribed a restricted calorie intake < 1600kcl/day diet, exercise at least 3 times a week for > 20 min and statins if hyperlipidemia was present.…”

“…In the setting of living liver donation, efforts have been targeted toward fat reduction using diet and exercise. [54] , [55] , [56] Studies in these setting have shown that weight reduction before donation is safe and grafts transplanted from these donors have comparable outcomes to grafts from donors without signs of steatosis. However, to this point, these studies have included a very limited number of patients.…”

“… 55 2020 7 7 NR, weight reduction was aimed 8-16 weeks Graft function of defatted livers similar to that of lean grafts Fujii et al. 56 2020 8 8 Diet, exercise ± statins 5-16 weeks Graft function of defatted livers similar to that of lean grafts NR, not reported. …”

“…Similar results were also reported by Fujii and colleagues. 56 In this study, potential donors diagnosed with fatty liver via CT scan were prescribed a restricted calorie intake <1,600 kcal/day diet, exercise at least 3 times a week for >20 min and statins if hyperlipidaemia was present. The weight reduction period was 35 to 109 days.…”

Hepatic connective tissue growth factor expression and regulation differ between non-steatotic and non-alcoholic steatotic livers from brain-dead donor

“…As the prevalence of hepatic steatosis is increasing globally, it is expected that a higher proportion of potential donors worldwide will have liver steatosis, thus influencing the quality of grafts 4 . Hepatic steatosis, inflammation, and fibrosis constitute the major risk factors of impaired liver graft function and predict liver-related mortality in patients with NAFLD [5][6][7] , which requires careful consideration during graft evaluation. Few study has investigated the impact factors and the underlying mechanism of liver steatosis under acute stress of brain death before organ procurement 8 .…”