Donor Selection for Adult-to-Adult Living Donor Liver Transplantation

Abstract

Background Donor selection criteria for adult-to-adult living donor liver transplantation vary with the medical center of evaluation. Living donor evaluation utilizes considerable resources and the non-maturation of potential into actual donors may sometimes prove fatal for patients with end stage liver disease. On the contrary, a thorough donor evaluation process is mandatory to ensure safe outcomes in otherwise healthy donors. We aimed to study the reasons for non-maturation of potential right lobe liver donors at our transplant center. Methods A retrospective data analysis of all potential living liver donors evaluated at our center from 1998 to 2010 was done. Results Overall 324 donors were evaluated for 219 potential recipients and 171 (52.7%) donors were disqualified. Common reasons for donor non-maturation included: (1) Donor reluctance, 21% (2) >10% macro-vesicular steatosis, 16% (3) assisted donor withdrawal, 14% (4) inadequate remnant liver volume, 13% (5) psychosocial issues, 7% and thrombophilia, 7%. Ten donors (6%) were turned down due to anatomical variations (8 biliary and 2 arterial anomalies). Donors older than 50 years and those with BMI over 25 were less likely to be accepted for donation. Conclusions We conclude that donor reluctance, hepatic steatosis and assisted donor withdrawal are major reasons for non-maturation of potential into actual donors. Anatomical variations and underlying medical conditions were not a major cause of donor rejection. A system in practice to recognize these factors early in the course of donor evaluation to improve the efficiency of the selection process and ensure donor safety is proposed.

Hepatic Steatosis: Assessment with Acoustic Structure Quantification of US Imaging

“…This result suggests that ASQ could be valuable for the preoperative detection of hepatic steatosis 10% or greater, which is critical in patients who undergo living donor liver transplantation because of the risks of initial graft dysfunction, poor graft survival, and other complications (8,9). The FD ratio was correlated with HFF (R 2 = 0.7515).…”

“…Although the disease prevalence of hepatic steatosis 10% or greater in the group of liver donor candidates was similar to that of previous studies (8,26), HFFs of included liver donor candidates (95% confidence interval: 3.14, 5.26) were too low to represent the range of HFF expected in clinical practice. To include larger HFFs, individuals suspected of having or who had evidence of hepatic steatosis were additionally included (95% confidence interval: 6.28, 11.05).…”

“…Furthermore, hepatic steatosis is an important risk factor for postoperative complications after major liver resection and living donor liver transplantation (3-7). Hepatic steatosis of 10% or greater is known to be critical in patients who undergo living donor liver transplantation because of the risks of initial graft dysfunction, poor graft survival, and other complications (8)(9)(10).…”

Robust sound speed estimation for ultrasound-based hepatic steatosis assessment

“…SSE strength is its ability to grade steatosis like MRI PDFF. Moreover, with both MRI PDFF and biopsy as gold standards, SSE was demonstrated to be valuable for hepatic steatosis 10% or greater detection, which is critical in patient who undergo living donor liver transplantation because of the risks of poor graft survival, initial graft dysfunction, and other complications (Trotter et al 2007, Sharma et al 2013.…”

Combined Use of MR Fat Quantification and MR Elastography in Living Liver Donors: Can It Reduce the Need for Preoperative Liver Biopsy?

“…; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, J. as hepatic steatosis or hepatic fibrosis, were the main reasons for exclusion from donation in potential adult living liver transplantation donors (7)(8)(9). Recently, nonalcoholic fatty liver disease (NAFLD), including nonalcoholic steatohepatitis (NASH), has increasingly been recognized as the most common chronic liver disease worldwide, with reports of an increasing prevalence of NASH in the United States (10).…”