Safe use of right lobe living donor livers with moderate steatosis in adult‐to‐adult living donor liver transplantation: a retrospective study

Abstract

Hepatic steatosis (HS) beyond a certain degree can jeopardize living donor (LD) safety, particularly in right lobe (RL) donors, making it a major obstacle for donor pool expansion in adult-to-adult living donor liver transplantation (ALDLT). From July 2004 to June 2016, 58 LDs donated their RLs despite having moderate HS (30%-50% steatosis) determined by intraoperative biopsy at a single center. We performed greedy matching to compare the outcomes of the donors and recipients of this group with those of LDs with no HS. The mean left lobe (LL) HS value in the 58 cases was 20.9 AE 12.4%, which was significantly lower than the mean RL HS value (38.8 AE 6.7%, P < 0.001). The mean ratio of the remnant LL to the total liver volume was 37.8 AE 2.2. No differences were observed in the postoperative liver function and donor and recipient morbidity and mortality rates. The liver regeneration rates in recipients and donors at 1 month, 6 months, and 1 year postoperatively did not differ significantly. The patient and graft survival rates of the recipients showed no differences. The use of well-selected RL grafts with moderate steatosis does not impair graft function, recipient outcomes, or donor safety.

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

“…3 Existing literature about donor weight loss includes donor BMI down to low 20s. [13][14][15][16][17] However, BMI in low 20s may not be achievable or even realistic expectation in many populations, due to lifestyle and genetic differences among populations. More importantly, limiting donor BMI to 20s would significantly reduce the number of potential donors.…”

“…Existing literature about donor weight loss includes donor BMI down to low 20s 13–17 . However, BMI in low 20s may not be achievable or even realistic expectation in many populations, due to lifestyle and genetic differences among populations.…”

Learning Curve of Ex Vivo Liver Resection and Autotransplantation in Treating End-Stage Hepatic Alveolar Echinococcosis: A RA-CUSUM Analysis

“…The intraoperative frozen section examination is also necessary to further affirm the quality of the residual liver. The additional pathological examination on remanent liver parenchyma may be helpful for early warning of postoperative liver function related complications ( 33 ), while some reports underrate the value of such endeavor ( 34 ). Finally, the highly individualized vessel reconstruction technique remains the bottleneck of ELRA.…”

Proceedings of the 27th Annual Congress of the International Liver Transplantation Society

“…Furthermore, machine perfusion and the manipulation of lipid metabolism during machine perfusion are promising tools to increase the utilization of steatotic organs. 15,16 Organ allocation is a continuing conundrum in 2022 (Dr Segev). Using computational tools to create a composite allocation score will balance medical urgency, posttransplant survival, candidate biology, patient access, and patient efficiency.…”

“…Furthermore, machine perfusion and the manipulation of lipid metabolism during machine perfusion are promising tools to increase the utilization of steatotic organs. 15,16…”