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04-03-2022 | Liver Transplantation | Original Article

Expanding donor pool for live donor liver transplantation: utilization of donors with non-alcoholic steatohepatitis after optimization

Authors: Viniyendra Pamecha, Nilesh Sadashiv Patil, Kumaraswamy Parthasarathy, Piyush Kumar Sinha, Nihar Mohapatra, Archana Rastogi, Karthika Rudrakumar, Amar Mukund, Ashok Chaudhary, Uma Kanal

Published in: Langenbeck's Archives of Surgery | Issue 4/2022

Abstract

Introduction

Potential live liver donors with non-alcoholic steatohepatitis (NASH) are rejected upfront for donation in live donor liver transplantation (LDLT). Herein, we share our experience of the feasibility of live liver donation in donors with NASH after successful donor optimization.

Materials and methods

Prospectively collected data of 410 consecutive donor hepatectomies from June 2011 to January 2018 were analyzed.

Results

During the study period, NASH was diagnosed histopathologically in 17 donors. Four donors were rejected in view of grade 2 fibrosis on histology. Out of remaining 13 donors, six became eligible for donation following lifestyle changes, dietary modifications, and target weight reduction of ≥5%. Reversal of NASH was confirmed on repeat liver biopsy in all the 6 donors. Five out of 6 underwent right lobe (without MHV) donor hepatectomies, while one had left lobe donation. These donors had significantly higher peak bilirubin levels in the immediate post-operative period as compared to other non-NASH donors (4.00 ± 0.32 vs. 2.57 ± 1.77 mg/dL, p = 0.043). In addition, post-hepatectomy normalization of hyperbilirubinemia, if any, was slower in donors with NASH (7 ± 1.3 vs. 5 ± 1.7 days, p = 0.016). However, none of these donors had post-hepatectomy liver failure. All these donors were discharged after an average hospital stay of 8 ± 1.7 days. Their respective recipients had uneventful post-operative courses without complications. Both the recipients and donors are having satisfactory liver functions after 46.7 ± 10.2 months of follow-up.

Conclusion

Scrupulous selection of live liver donors with NASH can open a door for expanding the organ pool in LDLT after a successful donor optimization program.

Pamecha V, Mahansaria SS, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK et al (2016) Selection and outcome of the potential live liver donor. Hepatol Int 10(4):657–664CrossRef

Fan ST, Lo CM, Liu CL, Yong BH, Chan JK, Ng IO (2000) Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg 135(3):336–340CrossRef

Oshita A, Tashiro H, Amano H, Kobayashi T, Onoe T, Ide K et al (2012) Safety and feasibility of diet-treated donors with steatotic livers at the initial consultation for living-donor liver transplantation.Transplantation. 93(10):1024–1030CrossRef

Choudhary NS, SarafN, Saigal S, Gautam D, Lipi L, RastogiA,et al. Rapid reversal of liver steatosis with lifestyle modification in highly motivated liver donors. J ClinExpHepatol 2015; 5(2):123–126

R. Agha, A. Abdall-Razak, E. Crossley, N. Dowlut, C. Iosifidis, G. Mathew, et al., STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery, Int J Surg 72 (2019) 156–165

Marsman WA, Wiesner RH, Rodriguez L, Batts KP, Porayko MK, Hay JE et al (1996) Use of fatty donor liver is associated with diminished early patient and graft survival. Transplantation. 62(9):1246–1251CrossRef

Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR (1999) Non-alcoholicsteatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94(9):2467–2474CrossRef

Pamecha V, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK (2016) Biliary complications after living donor hepatectomy: a first report from India. Liver Transpl 22(5):607–614CrossRef

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef

10.

Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D et al (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242(6):824–828CrossRef

11.

Olthoff KM, Kulik L, Samstein B, Abecassis M, Emond J, ShakedA,et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl 2010; 16(8):943–949

12.

Wong VW, Wong GL, Choi PC, Chan AW, Li MK, Chan HY et al (2010) Disease progression of non-alcoholic fatty liver disease: a prospective study with paired liver biopsies at 3 years. Gut. 59(7):969–974CrossRef

13.

Anurag L, Aniket S, Shalik J, Amarja L, Dhananjay R, Sachin J (2015) Non-alcoholic fatty liver disease prevalence and associated risk factors–a study from rural sector of Maharashtra. Trop Gastroenterol 36(1):25–30CrossRef

14.

Majumdar A, Misra P, Sharma S, Kant S, Krishnan A, Pandav CS (2016) Prevalence of nonalcoholic fatty liver disease in an adult population in a rural community of Haryana. India Indian J Public Health 60(1):26–33CrossRef

15.

Das K, Das K, Mukherjee PS, Ghosh A, Ghosh S, Mridha AR et al (2010) Nonobese population in a developing country has a high prevalence of non-alcoholic fatty liver and significant liver disease. Hepatology. 51(5):1593–1602CrossRef

16.

Wei JL, Leung JC, Loong TC, Wong GL, Yeung DK, Chan RS et al (2015) Prevalence and severity of non-alcoholic fatty liver disease in non-obese patients: a population study using proton-magnetic resonance spectroscopy. Am J Gastroenterol 110(9):1306–1314CrossRef

17.

Cruz AC, Bugianesi E, George J, Day CP, Liaquat H, Charatcharoenwitthaya P et al (2014) Characteristics and long-term prognosis of lean patients withnon-alcoholic fatty liver disease. Gastroenterology. 146(5):S-909CrossRef

18.

Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E et al (2011) Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 54(3):1082–1090CrossRef

19.

Ballestri S, Mantovani A, Byrne C, Lonardo A, Targher G. Diagnostic accuracy of ultrasonography for the detection of hepatic steatosis: an updated meta-analysis of observational studies. Metabolism and Target Organ Damage 2021 Sep 7;1(7)

20.

EASL-EASD-EASO (2016) Clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 64(6):1388–1402

21.

Ryan CK, Johnson LA, Germin BI, Marcos A (2002) One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation. Liver Transpl 8(12):1114–1122CrossRef

22.

Haberal M, Telatar H, Demirag A, Boyacioğlu S, Bilgin N (1995) Is needle biopsy mandatory for donor selection in live donor segmental liver transplantation? Transplant Proc 27(5):2605–2606PubMed

23.

Bashir S, Mittal K, Khisti R, Yadav A, Mukund A, Pamecha V (2018) Portal vein thrombosis after donor liver biopsy: case report. The Indian journal of radiology & imaging 28(1):61CrossRef

24.

Hwang S, Lee SG, Jang SJ, Cho SH, Kim KH, Ahn CS et al (2004) The effect of donor weight reduction on hepatic steatosis for living donor liver transplantation. Liver Transpl 10(6):721–725CrossRef

25.

Nakamuta M, Morizono S, Soejima Y, Yoshizumi T, Aishima S, Takasugi SI et al (2005) Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation. Transplantation. 80(5):608–612CrossRef

26.

Ozawa Y, Tamura T, Owada Y, Shimizu Y, Kemmochi A, Hisakura K et al (2018) Evaluation of safety for hepatectomy in a novel mouse model with nonalcoholic-steatohepatitis. World J Gastroenterol 24(15):1622CrossRef

27.

Hoppe S, von Loeffelholz C, Lock JF, Doecke S, Sinn BV, Rieger A et al (2015) Nonalcoholic steatohepatitis and liver steatosis modify partial hepatectomy recovery. J Investig Surg 28(1):24–31CrossRef

28.

Buechter M, Thimm J, Baba HA, Bertram S, Willuweit K, Gerken G et al (2019) Liver maximum capacity: a novel test to accurately diagnose different stages of liver fibrosis. Digestion. 100(1):45–54CrossRef

29.

Alizai PH, Lurje I, Kroh A, Schmitz S, Luedde T, Andruszkow J et al (2019 Feb) Noninvasive evaluation of liver function in morbidly obese patients. Gastroenterol Res Pract 3:2019

30.

Vauthey JN, Pawlik TM, Ribero D, Wu TT, Zorzi D, Hoff PM et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24(13):2065–2072CrossRef

31.

Reddy SK, Marsh JW, Varley PR, Mock BK, Chopra KB, Geller DA et al (2012) Underlying steatohepatitis, but not simple hepatic steatosis, increases morbidity after liver resection: a case-control study. Hepatology. 56(6):2221–2230CrossRef

32.

Yamamoto K, Takada Y, Fujimoto Y, Haga H, Oike F, Kobayashi N, et al. Nonalcoholicsteatohepatitis in donors for living donor liver transplantation. Transplantation 2007; 83(3):257–62

33.

Pamecha V, Bharathy KG, Mahansaria SS, Sinha PK, Rastogi A, Sasturkar SV (2018) “No go” donor hepatectomy in living-donor liver transplantation. Hepatol Int 12(1):67–74CrossRef

34.

Taitano AA, Markow M, Finan JE, Wheeler DE, Gonzalvo JP, Murr MM (2015) Bariatric surgery improves histological features of non-alcoholic fatty liver disease and liver fibrosis. J Gastrointest Surg 19(3):429–437CrossRef

35.

Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR et al (2010) Randomized controlled trial testing the effects of weight loss on non-alcoholic steatohepatitis. Hepatology 51(1):121–129CrossRef

36.

Golabi P, Locklear CT, Austin P, Afdhal S, Byrns M, Gerber L et al (2016) Effectiveness of exercise in hepatic fat mobilization in non-alcoholic fatty liver disease: systematic review. World J Gastroenterol 22(27):6318–6327CrossRef

Title: Expanding donor pool for live donor liver transplantation: utilization of donors with non-alcoholic steatohepatitis after optimization
Authors: Viniyendra Pamecha
Nilesh Sadashiv Patil
Kumaraswamy Parthasarathy
Piyush Kumar Sinha
Nihar Mohapatra
Archana Rastogi
Karthika Rudrakumar
Amar Mukund
Ashok Chaudhary
Uma Kanal
Publication date: 04-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Published in: Langenbeck's Archives of Surgery / Issue 4/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02444-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Expanding donor pool for live donor liver transplantation: utilization of donors with non-alcoholic steatohepatitis after optimization

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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