Outcomes of right lobe donors with BMI≥30 for living donor liver transplantation

Andaçoğlu, Oya; Tokat, Yaman; Malamutmann, Eugen; Adali, Güpse; Emre, Anilalp; Oezcelik, Arzu

doi:10.1111/ctr.14698

Cited by 5 publications

(11 citation statements)

References 18 publications

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“…The incidence of donor wound infection increased as BMI exceeded 30 kg/m 2 ; however, it was not associated with significant morbidity [420]. A comparison of the outcomes of donors and recipients between the BMI less than 30 kg/m 2 group and the BMI above 30 kg/m 2 group without steatosis revealed no differences between both groups [421][422][423]. Obesity has been defined as a BMI > 30 kg/m 2 in the West, while a BMI > 25 kg/m 2 in the Asia-Pacific region is regarded as obesity [424].…”

Section: Donor Selectionmentioning

confidence: 93%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines. Keywords Living donor liver transplantation • Deceased donor liver transplantation • Multidisciplinary • GradeSpecial consideration: LDLT in ACLF In a study of 112 LDLT recipients with ACLF, defined by the APASL definition, post-LT outcomes were excellent (92.9% at 5 years) [69]. In a study on high-model end-stage liver disease (MELD) (score ≥ 30) LDLT recipients with ACLF (n = 190), defined by the World Congress of Gastroenterology [70], the 5-year survival rate was 72.1% [71]. In a study of 117 LDLT recipients who had ACLF, as defined by the EASL-CLIF definition, post-transplant survival after LDLT was 92.9%, 85.4%, and 75.6% at 1 year, while mortality rate without LT was 28.5%, 77.7%, and 93.4% at 90 days, for ACLF grades 1, 2, and 3, respectively [72]. These data indicate that LDLT can be a life-saving treatment option for patients with ACLF.LDLT differs significantly from DDLT, as the timing of LDLT can be determined by the transplant team. There are advantages and disadvantages of LDLT in the setting of ACLF. The benefit of LDLT in patients with ACLF is its ability to provide rapid transplantation to critically ill patients [73], without waiting for deceased donor allocation. The ideal time for LT can be selected by transplant team when willing living donor is available. If ideal time for LT can be selected in the dynamic course of ACLF, this may improve post-LT outcome. The disadvantages of LDLT include the need for healthy, willing liver donor, and the use of partial grafts for critically ill patients. A graft-to-recipient weight ratio (GRWR) is a factor associated with post-LT outcomes in LDLT [74]. The donor risk index is a factor associated with post-LT outcomes for patients with ACLF who received DDLT [66,75]. This indicates that DDLT, which uses whole liver grafts, might be a better compared to LDLT, which uses partial grafts, in ACLF. In addition, there are uncertainties regarding the criteria for living donor graft quality that is required for critically ill patients with ACLF. In studies that reported...

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Section: Donor Selectionmentioning

confidence: 93%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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“…With respect to guidelines, all obese donors were evaluated for comorbidities before inclusion-especially hepatic steatosis-and had similar preoperative characteristics to non-obese donors in all studies. No significant differences were observed in the rate of complications at 30 days [ 20 – 22 ] except for wound complications.…”

Section: Obese Donors’ Outcomesmentioning

confidence: 99%

“…Findings of interest in this subgroup included higher rates of grade 1 or 2 steatosis and biliary complications. [ 22 ] A recent meta-analysis of 6 studies included 102 obese donors who achieved a mean reduction in BMI of -2.08. Results were promising, with 91.2% achieving reduction/resolution of steatosis, a mean difference of -21.2% steatosis on biopsy, and similar post-operative outcomes to the control group with no steatosis.…”

Section: Pre-transplant Bmi Optimizationmentioning

confidence: 99%

Practice patterns and considerations in liver transplantation from living donors with high BMI: A review

Samaha

2023

Hepatology Forum

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Living Donor Liver Transplantation (LDLT) is a valuable solution to the shortage of donor organs for patients with end-stage liver disease. However, the eligibility of obese donors for LDLT remains a subject of debate. This literature review explores global practices and perceptions of LDLT, identifies donor eligibility criteria, and discusses special considerations and ethical caveats. The review highlights the need for standardized guidelines for donor selection, considering the global distribution of Body mass index and variations in population-specific criteria. It also emphasizes the importance of non-invasive testing and pre-operative optimization of liver steatosis for select obese donors. Furthermore, the review examines the outcomes and complications associated with obese donors in LDLT. The findings of this review contribute to the ongoing discussion on the inclusion of obese donors in LDLT and provide insights for future research and guideline development.

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“…These interventions usually take 4-12 wk leading to loss of valuable time and resources for donors and recipients. 2,3 Lately, there has been a rise in the use of living donors with BMI >30 kg/m 2 with conflicting reports on the associated outcomes in the literature. A recent study observed a significant increase in wound infection rates in donors with obesity, while Dirican et al 4 noted significantly higher rates of Clavien-Dindo grade IIIb complication in extended criteria donors defined as either BMI ≥30 kg/m 2 , age >55 y, or remnant liver volume <30%.…”

mentioning

confidence: 99%

“…5,6 In contrast, others have found no difference in the rates of complications, length of hospital stay (LOS), operative time, or recovery after donation from donors who were overweight or obese. 2,7 Currently, available literature is based on single center or pooled data with small sample size and shorter duration of follow-up. There has been no investigation of national US data on the impact of donor BMI on donor and recipient outcomes.…”

mentioning

confidence: 99%

The Impact of Donor Body Mass Index on Safety and Outcomes in Living Donor Liver Transplantation: An Analysis of the National United States Database

Banker,

Cywes,

Muñoz

et al. 2024

Transplantation Direct

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Background. The prevalence of obesity is rising in the general population. Donor obesity (body mass index ≥30 kg/m2) may potentially reduce the donor pool and impact outcomes in living donor liver transplantation (LDLT). Methods. We utilized the national transplant database to investigate the impact of donor obesity on donor and recipient outcomes. This was a retrospective cohort study of all LDLTs performed in the United States between January 2010 and June 2023. Outcomes of interest were analyzed by univariable and multivariable logistic regression. Patient and graft survival was evaluated using Kaplan-Meier and Cox proportional analysis. Results. Six hundred seventy-four donors with obesity and 3498 donors without obesity were analyzed. Donors with obesity had higher rates of readmission within 1 y of donation (15.9% versus 11.6%; P = 0.003). The risk of readmission was significantly different between 6 wk and 6 mo of donation (8.8% versus 5.9%; P = 0.036). Donor body mass index (odds ratio [OR], 1.460; 95% confidence interval [CI], 1.129-1.999; P = 0.004) and preoperative alkaline phosphatase levels (OR, 1.005; 95% CI, 1.000-1.011; P = 0.038) were independent predictors of donor readmission. High LDLT center volume was associated with reduced odds of donor readmission (OR, 0.509; 95% CI, 0.373-0.694; P < 0.001). Graft and recipient survival was comparable. Conclusions. Selection of living donors with obesity may be a potential avenue to increase the available donor pool without compromising recipient outcomes; however, they are at an increased risk for readmission between 6 wk and 6 mo of donation. The reason for readmission requires further study.

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Outcomes of right lobe donors with BMI≥30 for living donor liver transplantation

Cited by 5 publications

References 18 publications

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Practice patterns and considerations in liver transplantation from living donors with high BMI: A review

The Impact of Donor Body Mass Index on Safety and Outcomes in Living Donor Liver Transplantation: An Analysis of the National United States Database

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