Evaluation of the donor liver for living donor liver transplantation

Outcomes of donor evaluation in adult-to-adult living donor liver transplantation

“…The primary reason for not accepting donor candidates was categorized as donor or recipient related. Donor reasons included: (1) medical contraindication (diagnosis of medical condition that could increase the risk of short-term or long-term complications in the donor candidate, such as hypertension, abnormal blood chemistries, or chest radiograph); (2) anatomic considerations (findings on hepatic crosssectional imaging that either increase the risk of hepatectomy in the donor candidate, for example, large hemangioma, or preclude the donor candidate from yielding a suitable graft, for example, significantly abnormal hepatic vasculature, or both); (3) donor candidate declined to donate; (4) hepatic histology showing steatosis greater than 10%; or (5) psychosocial contraindications, such as active substance abuse. Recipient reasons included: (1) recipients who declined the donor's offer or (2) recipients who had a change in condition precluding the feasibility of or need for LDLT [improvement, deterioration, receipt of a deceased donor liver transplant (DDLT), or death].…”

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

“…According to a previous study performed in a single transplantation center, the prevalence of NAFLD diagnosed with biopsy was 51.4% among 589 potential living liver donors (16). However, ultrasonography (US) and CT have shown limitations in the detection of clinically significant hepatic steatosis or NASH in liver donors (16)(17)(18); as a result, preoperative liver biopsy continues to be regarded as an essential part of living liver donor work-ups in many centers (17,19,20). On the other hand, there are also many centers where only selected potential donors with potential clinical risk factors, such as high body mass index (BMI), abnormal liver enzyme levels, or abnormal imaging findings at US or CT, undergo preoperative liver biopsy (12,21) because it is an invasive procedure with the problem of high interobserver variation (12,22 level, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT), g-glutamyl transpeptidase (gGT), and platelet count.…”

Effects of N-acetylcysteine on regeneration following partial hepatectomy in rats with nonalcoholic fatty liver disease

“…Thus, while many centers stipulate steatosis levels of lower than 10% for living donors, levels of greater than 30% are considered unacceptable. 7 The increased susceptibility to hepatic ischemiareperfusion injury and the impaired regeneration capacity of the liver with NAFLD contribute to less favorable outcomes. 4 Although the reasons for poor liver regeneration capacity are controversial, two major hepatocellular injury mechanisms have been defi ned: impaired sinusoidal blood fl ow, reported by Ohara 8 as a reduction in the fatty liver sinusoidal fi eld of up to 53%; and oxidative stress and failure to meet energy requirements caused by the alterations in cellular metabolism in the fatty liver.…”