Background

Living donor liver transplantation using hepatic steatosis-improved grafts mitigates donor shortage. Herein, we aimed to evaluate the safety and feasibility of right-lobe adult-to-adult living donor liver transplantation using grafts improved through donor weight loss.

Methods

In this retrospective study conducted in a single institution in the Republic of Korea, we reviewed the medical records of living liver donors who lost ≥ 10% of their body weight to improve steatosis before right lobe donation between January 2015 and December 2020. Overall, 1040 right-lobe donors were included, with 150 and 890 donors in the weight loss and control (non-steatosis) groups, respectively.

Results

We performed 1:1 individual matching using the greedy matching method, by which 124 patients were included in each group. The median period from the date of the first visit to donation was 113 (interquartile range: 78–184) days in the weight loss group. As body weight changed from 82.8 ± 13.7 kg to 70.8 ± 11.8 kg (p < 0.0001), body mass index also improved from 27.8 ± 3.9 kg/m² to 23.8 ± 3.1 kg/m² (p < 0.0001). No significant between-group differences existed in the postoperative laboratory data for living donors and recipients. The incidence of postoperative complications in donors was comparable between the groups (control group, 9.7%; weight loss group, 13.7%; p = 0.3185). The graft and recipient survival rates were comparable between the groups (p = 1.000).

Conclusion

Weight loss through diet and exercise significantly could improve hepatic steatosis in living donor candidates for liver transplantation, with the surgical outcomes in recipients and donors being equivalent to those in recipients and non-steatotic donors.

中文翻译：

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活体捐赠者通过减肥改善脂肪变性后右肝捐赠的安全性：一项回顾性研究

背景

使用改善肝脏脂肪变性的移植物进行活体肝移植可以缓解供体短缺的问题。在此，我们的目的是评估使用通过供体减重改善的移植物进行右叶成人对成人活体肝移植的安全性和可行性。

方法

在这项在韩国一家机构进行的回顾性研究中，我们回顾了 2015 年 1 月至 2020 年 12 月期间在右叶捐赠前体重减轻 ≥ 10% 以改善脂肪变性的活体肝脏捐赠者的医疗记录。总体而言，1040右叶捐献者也被纳入其中，减肥组和对照组（非脂肪变性）分别有 150 名和 890 名捐献者。

结果

采用贪婪匹配法进行1:1个体匹配，每组共纳入124例患者。减肥组从第一次就诊到捐献的平均时间为 113 天（四分位距：78-184）天。随着体重从 82.8 ± 13.7 kg 变化至 70.8 ± 11.8 kg ( p  < 0.0001)，体重指数也从 27.8 ± 3.9 kg/m ²改善至 23.8 ± 3.1 kg/m ² ( p  < 0.0001)。活体供体和受体的术后实验室数据不存在显着的组间差异。各组供体术后并发症的发生率相当（对照组，9.7%；减肥组，13.7%；p  = 0.3185）。各组之间的移植物和受体存活率具有可比性 ( p  = 1.000)。

结论

通过饮食和运动减轻体重可以显着改善肝移植活体供体候选者的肝脂肪变性，受者和供者的手术结果与受者和非脂肪变性供者的手术结果相同。