The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool

Al–Hamoudi, Waleed; Abaalkhail, Faisal; Bendahmash, Abdurahman; Allam, Naglaa; Hegab, Bassem; Elsheikh, Yasser; Al-Bahili, Hamad; AlMasri, Nasser; Al-Sofayan, M.; Alabbad, Saleh; Al-Sebayel, Mohammed; Broering, Dieter; Elsiesy, Hussien

doi:10.1007/s12072-015-9664-7

Cited by 11 publications

(14 citation statements)

References 44 publications

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“…Though genetically unrelated transplantation is allowed, it comprises <2% of transplants. Donors are scrutinized by an independent selection committee before they are accepted as candidates for donation …”

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

“…Living donor suitability has been an issue; high body mass index and fatty liver have been the main contraindications to living donation. The high prevalence rate of these contraindications has been related to the increased incidence of morbid obesity in the Saudi population as a result of the change in socioeconomic status and the adoption of a Western lifestyle . Those who do not have a donor are put on the waiting list for a DDLT.…”

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

“…Donors are scrutinized by an independent selection committee before they are accepted as candidates for donation. (10) Cadaveric donors are referred through SCOT, which works with the donating hospital on the donation logistics. Allocation is currently center-oriented so that organs are distributed by SCOT equally and in turn among the 4 centers.…”

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

“…The high prevalence rate of these contraindications has been related to the increased incidence of morbid obesity in the Saudi population as a result of the change in socioeconomic status and the adoption of a Western lifestyle. (10) Those who do not have a donor are put on the waiting list for a DDLT. At KFSHRC, the wait-list mortality rate is approximately 30%.…”

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

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Liver transplantation in the Kingdom of Saudi Arabia

Sebayel¹,

Abaalkhail²,

Abbad³

et al. 2017

Liver Transpl

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The first liver transplantation (LT) in Saudi Arabia was performed in 1991; however, it was not until 1994 that the first structured LT program was launched. Until 1997, all LTs in the Kingdom of Saudi Arabia (KSA) were deceased donor liver transplantations. Programs performing LTs needed the authorization of the Saudi Center for Organ Transplantation (SCOT), which provides the essential support for organ procurement and allocation as well as regulatory support for organ transplantation in the country. Currently, there are 4 LT centers in the KSA. Three centers are in Riyadh, the capital city of KSA, and 1 is in the city of Dammam in the Eastern province. Pediatric living donor liver transplantation (LDLT) began in 1997, while the adult LDLT program started 4 years later in 2001. Currently, more than 2000 LTs have been performed by the 4 centers in the KSA. Over 50% of those were performed at King Faisal Specialist Hospital and Research Center in Riyadh. The outcomes of these transplants have been comparable with the international standards. The aim of this review is to provide an overview of LT in KSA. Liver Transplantation 23 1312-1317 2017 AASLD.

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Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

Section: Current Demand For and Means Of Access To Liver Transplantationmentioning

confidence: 99%

See 2 more Smart Citations

Liver transplantation in the Kingdom of Saudi Arabia

Sebayel¹,

Abaalkhail²,

Abbad³

et al. 2017

Liver Transpl

Self Cite

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“…Other selection criteria such as upper age limit, body mass index (BMI), and degree of steatosis are often arbitrarily set by transplant centers on the basis of donor safety without any definite scientific basis. These result in a donor acceptance rate that ranges from 13% to 39%, and there are widely different reasons for donor rejection in different centers. For example, the adoption of a very cautious approach in donor selection with an upper BMI set at 28 kg/m has resulted in obesity being the most common reason for donor rejection .…”

Section: Expanding Donor Poolmentioning

confidence: 99%

Expanding living donor liver transplantation

2016

Liver Transpl

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Evaluating the living donor: expansion by innovation

2016

Hepatol Int

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Living donor liver transplantation (LDLT) provides an alternative for patients with end-stage liver disease to receive a life-saving transplant operation. As compared to deceased donor liver transplantation, LDLT is both surgically and ethically more challenging, as the operation involves taking a partial liver graft from a healthy living donor. The evaluation and selection of a living donor is a more complicated process which can be no less controversial than the donor operation itself. There are three main objectives. The first is to determine that a part of the donor's liver can be used reliably as a graft for the recipient. The second is to ensure the safety of the donor. The final objective is to assess the outcome of the recipient including the risks and benefits as compared to a deceased donor liver transplant. To ensure the safety of the operation, particularly for the donor, the pretransplant evaluation of a potential living donor according to a planned protocol and criteria is mandatory. There is extremely wide variation in the practice of donor evaluation among different transplant centers because of differences in the availability of deceased donor grafts, experience in LDLT, prevalence of various diseases, and socio-cultural factors.Metabolic syndrome, which includes a combination of obesity, diabetes, hypertension and dyslipidemia, represents a common risk factor for premature cardiovascular disease [1]. It is also closely but not causally related to nonalcoholic fatty liver disease (NAFLD) [2] which spans from steatosis to steatohepatitis. Hence, the presence of metabolic syndrome may potentially increase the operative risk of a living liver donor for both reasons. In this issue of the journal, Al-hamoudi et al. summarizes the outcome of 1065 potential donors who were evaluated for living liver donation at the King Faisal Hospital in Saudi Arabia [3], and identified elements of metabolic syndrome as the most common reasons for rejecting potential living liver donors. In potential donors for adults, the donation rate was only 13 %, with the most common reasons for rejection being a body mass index [28 in 28 % and diabetes in 19.2 %. Hepatic steatosis [10 % on radiologic imaging or liver biopsy was the reason for rejection in an additional 8 % of the donors. As a high volume center with an average of 40 LDLTs per year, which accounted for over 50 % of the annual case load of liver transplants, this experienced group from King Faisal Hospital has adopted a very cautious approach in donor selection with an upper age limit set at 45 years, a body mass index (BMI) under 28, and a policy of routine liver biopsy with the aim of accepting only donors with steatosis \10 %. The reasons as well as the consequences of such a cautious approach are obvious when considering the prevalence of metabolic syndrome in Saudi Arabia which is 10-15 % higher than in most developed countries [4].It is interesting to compare this experience from Saudi Arabia with the Hong Kong experience in a predominantly Chinese community...

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The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool

Abstract: Metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.

Cited by 11 publications

References 44 publications

Liver transplantation in the Kingdom of Saudi Arabia

Liver transplantation in the Kingdom of Saudi Arabia

Expanding living donor liver transplantation

Evaluating the living donor: expansion by innovation

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