Safe Use of Right Lobe Live Donor Livers With up to 20% Macrovesicular Steatosis Without Compromising Donor Safety and Recipient Outcome

Abstract

Background. The principle in right lobe living donor liver transplantation is to use “near-perfect” grafts to maximize recipient benefit with minimal donor risk. Whether and what degree of graft macrovesicular steatosis is safe for both recipient and donor is debatable. Methods. We compared donor and recipient outcomes in 623 primary right lobe living donor liver transplantations, using grafts with (Group A; 10%–20% steatosis, n = 92) and without (Group B; <10%, n = 531) significant macrovesicular steatosis, on pre- or intraoperative biopsy. Results. Group A donors had higher body mass index, transaminases, fasting blood sugar, triglyceride, low density lipoprotein level, and lower high density lipoprotein, and liver attenuation index on CT scan, and similar future liver remnant. Mean postoperative day (POD) 7, aspartate aminotransferase (61.13 + 24.77 vs 73.17 + 53.71 IU/L; P = 0.04), and prothrombin time-international normalized ratio (1.16 + 0.36 vs 1.28 + 0.24; P = 0.0001) were lower in Group A donors. POD3 of 7 total bilirubin and alanine aminotransferase; POD3 aspartate aminotransferase and prothrombin time-international normalized ratio; postoperative morbidity (Dindo-Clavien >3b), hospital stay were similar in both groups. Recipients in both groups had similar age, model for end-stage liver disease score. Right lobe graft weight (764.8 + 145.46 vs 703.24 + 125.53 grams; P < 0.0001) and GRWR (1.09 + 0.29 vs 1.00 + 0.21; P = 0.0004) were higher in Group A. All biochemical parameters at POD 3 of 7, as well as hospital stay, 30-day mortality were similar in recipients of both groups, even after matching both groups for age, model for end-stage liver disease, and GRWR. Conclusions. Use of well-selected right lobe grafts (adequate future liver remnant in donor, GRWR in recipient), with up to 20% macrovesicular steatosis, does not compromise graft function and outcomes and is safe for the donor.

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

“…[1,9,[23][24][25] In contrast, HS < 30% neither increased postoperative complication and mortality rates nor impaired longterm regeneration in LDs. [8,10,15] Figure 1 The 1-, 5-, and 10-year graft survival rates for adult-to-adult living donor liver transplantation (ALDLT) with moderate (30%-50% steatosis) and no hepatic steatosis (HS) Liver regeneration is critical in LDLT, because it involves a partial liver graft intended to meet the metabolic demands of both the recipient and LD. In animal studies, severe steatosis with prominent inflammation negatively affected hepatocyte proliferation and resulted in impaired regeneration of the remnant liver after extensive (70%) hepatectomy.…”

“…[1] In LDLT, liver regeneration was not impaired in grafts with mild steatosis (Mac HS < 30%). [9,15] However, there are no reports on liver regeneration after ALDLT in LDs with moderate or severe HS in human subjects, especially regarding LD safety. In the present study, while the regeneration of the remnant LL in LDs was not significant between the moderate HS and no-HS groups, the regeneration rate at 1 month and 6 months after donation was different, with the moderate HS group being higher than the no-HS group.…”

“…[1,9,23‐25] In contrast, HS < 30% neither increased postoperative complication and mortality rates nor impaired long‐term regeneration in LDs. [8,10,15]…”

“…[11,12] Several recent studies have demonstrated acceptable recipient outcomes following LDLT with a steatotic graft; however, the study populations were small, most grafts were left lobe (LL) grafts, and the degrees of HS were mild (<30%). [7,10,[13][14][15] The primary aim of our study was to review our experiences with RL adult-toadult LDLT (ALDLT) in donors with moderate HS (30%-50% steatosis) and evaluate its safety and feasibility by comparing the outcomes of such donors and recipients with those of RL ALDLT in LDs with no HS.…”

Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria

“…( 22 ) A graft‐to‐recipient weight ratio (GRWR) of 0.8% was desirable, but as low as 0.6% to 0.7% was accepted in patients with Model for End‐Stage Liver Disease (MELD) scores (without HCC exception points) lower than 19. ( 23 ) The minimum acceptable future liver remnant in the donor was 30% of the total liver volume estimated on CT scan prior to transplant.…”