Revisiting donor risk over two decades of single-center experience: More attention on the impact of overweight

Ho, Cheng‐Maw; Huang, Yu‐Min; Hu, Rey‐Heng; Wu, Yao‐Ming; Ho, Ming-Chih; Lee, Po‐Huang

doi:10.1016/j.asjsur.2018.01.002

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…reported right lobe donation and overweight (BMI ≥ 25) were significant factors associated with donor morbidity 12 . Interestingly, they reported that being overweight was a paradoxical risk factor in right donor hepatectomy but not in left liver donors 12 . All of our grafts were right lobe therefore we cannot comment on the impact of BMI for left liver donation.…”

Section: Discussionmentioning

confidence: 87%

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

Andaçoğlu

Tokat

Malamutmann³

et al. 2022

Clinical Transplantation

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Background: Donor BMI above 30 is generally considered contraindication for donor hepatectomy. We compared the donor outcomes based on BMI threshold and weight loss.Patients and methods: All potential donors were identified and data were collected retrospectively. Steatosis was assessed based on liver-spleen Hounsfield unit difference and absolute liver intensity values. We compared BMI≥30 (n = 53) and BMI < 30 (n = 64) donor outcomes. Donors with weight loss (WL) prior to surgery were also analyzed separately. Complications were graded by Clavien-Dindo classification. Results:All donors underwent open right donor hepatectomy. There was no difference between BMI≥30 and < 30 groups except female predominance in BMI≥30 group (P = .006). Both groups had similar rates of complication rates in all categories, similar remnant volume, operative time, length of stay and similar postoperative liver function recovery (all P > .05). On the other hand, donors with WL were more commonly male, had smaller graft size, and higher biliary complications rates compared to no-WL donors (all P < .05). Multivariate binary logistics regression analysis revealed no association between BMI or WL and outcomes. Conclusion:We demonstrate that donors with BMI≥30 have similar outcomes compared to BMI < 30 donors with our defined selection criterion, therefore BMI≥30 is not an absolute contraindication to donate right liver, provided that there is no significant steatosis and remnant liver is satisfactory. For potential overweight donors, WL down to BMI < 30 is a reasonable target. Higher biliary complication rates after WL should be investigated further.

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Section: Discussionmentioning

confidence: 87%

“…On the other hand, Ho et al. reported right lobe donation and overweight (BMI ≥ 25) were significant factors associated with donor morbidity 12 . Interestingly, they reported that being overweight was a paradoxical risk factor in right donor hepatectomy but not in left liver donors 12 .…”

Section: Discussionmentioning

confidence: 99%

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

Andaçoğlu

Tokat

Malamutmann³

et al. 2022

Clinical Transplantation

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“…Based on their blood test result, age and BMI those individuals were considered in the study who have a perfect liver. In our recent work, it was described that ten years of a survey of 473 liver donors morbidity after liver hepatectomy 31 . This study describes that the average age of liver donors is not more than 30 years.…”

Section: Methodsmentioning

confidence: 99%

A pilot study for the prediction of liver function related scores using breath biomarkers and machine learning

Patnaik

Lin

Agarwal

et al. 2022

Sci Rep

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Volatile organic compounds (VOCs) present in exhaled breath can help in analysing biochemical processes in the human body. Liver diseases can be traced using VOCs as biomarkers for physiological and pathophysiological conditions. In this work, we propose non-invasive and quick breath monitoring approach for early detection and progress monitoring of liver diseases using Isoprene, Limonene, and Dimethyl sulphide (DMS) as potential biomarkers. A pilot study is performed to design a dataset that includes the biomarkers concentration analysed from the breath sample before and after study subjects performed an exercise. A machine learning approach is applied for the prediction of scores for liver function diagnosis. Four regression methods are performed to predict the clinical scores using breath biomarkers data as features set by the machine learning techniques. A significant difference was observed for isoprene concentration (p < 0.01) and for DMS concentration (p < 0.0001) between liver patients and healthy subject’s breath sample. The R-square value between actual clinical score and predicted clinical score is found to be 0.78, 0.82, and 0.85 for CTP score, APRI score, and MELD score, respectively. Our results have shown a promising result with significant different breath profiles between liver patients and healthy volunteers. The use of machine learning for the prediction of scores is found very promising for use of breath biomarkers for liver function diagnosis.

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“…Live donor liver transplantation (LDLT) is the primary treatment option for endstage liver disease in countries that have organ shortages [1,2]. LDLT also provides a timely rescue for transplant candidates who may not survive long enough to receive liver transplants from deceased donors [3] However, live liver donation surgeries are not without risks and complications [4,5] Therefore, much effort has been devoted to expanding the maximal operability of live liver donations [6] and to reducing complications as much as is feasible.…”

Section: Introductionmentioning

confidence: 99%

Circuitous Path to Live Donor Liver Transplantation from the Coordinator’s Perspective

Lin

Hsieh

et al. 2021

JPM

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Background: The live donor liver transplantation (LDLT) process is circuitous and requires a considerable amount of coordination and matching in multiple aspects that the literature does not completely address. From the coordinators’ perspective, we systematically analyzed the time and risk factors associated with interruptions in the LDLT process. Methods: In this retrospective single center study, we reviewed the medical records of wait-listed hospitalized patients and potential live donors who arrived for evaluation. We analyzed several characteristics of transplant candidates, including landmark time points of accompanied live donation evaluation processes, time of eventual LDLT, and root causes of not implementing LDLT. Results: From January 2014 to January 2021, 417 patients (342 adults and 75 pediatric patients) were enrolled, of which 331 (79.4%) patients completed the live donor evaluation process, and 205 (49.2%) received LDLT. The median time from being wait-listed to the appearance of a potential live donor was 19.0 (interquartile range 4.0–58.0) days, and the median time from the appearance of the donor to an LDLT or a deceased donor liver transplantation was 68.0 (28.0–188.0) days. The 1-year mortality rate for patients on the waiting list was 34.3%. Presence of hepatitis B virus, encephalopathy, and hypertension as well as increased total bilirubin were risk factors associated with not implementing LDLT, and biliary atresia was a positive predictor. The primary barriers to LDLT were a patient’s critical illness, donor’s physical conditions, motivation for live donation, and stable condition while on the waiting list. Conclusions: Transplant candidates with potential live liver donors do not necessarily receive LDLT. The process requires time, and the most common reason for LDLT failure was critical diseases. Aggressive medical support and tailored management policies for these transplantable patients might help reduce their loss during the process.

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Revisiting donor risk over two decades of single-center experience: More attention on the impact of overweight

Abstract: The overall complication rate was 20.9%. Overweight might be protective against morbidity in right hepatectomy and warrants further deliberation.

Cited by 7 publications

References 26 publications

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

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

A pilot study for the prediction of liver function related scores using breath biomarkers and machine learning

Circuitous Path to Live Donor Liver Transplantation from the Coordinator’s Perspective

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