Ann Liver Transplant.  2023 Nov;3(2):113-117. 10.52604/alt.23.0014.

Short-term weight reduction program in potential donors with severe steatosis can reduce liver volume significantly that changes clinical decision in living donor transplantation

• Kim Y
• Lee KW
• Choi Y
• Hong Sy
• Yi NJ
• Hong SK
• Lee JM
• Suh KS

• KMID: 2560932
• DOI: http://doi.org/10.52604/alt.23.0014

Abstract

Short-term weight reduction (SWR) programs have been demonstrated to ameliorate liver steatosis, transforming marginal donors into viable candidates for living donor liver transplantation (LDLT). These interventions impact objective indices of liver health through non-invasive imaging tools, expanding the pool of potential donors. Graft-to-recipient weight ratio (GRWR) is one of the important factors in recipient safety, therefore, needs to be considered for graft selection. A low GRWR can lead to impaired function, while a high GRWR can cause graft compression issues. We experienced one LDLT case that SWR program of the donor reduced the volume of the liver significantly together with qualitative improvement and changed a clinical decision to switch from using the left liver to the right liver as the graft during surgery. A healthy donor with fatty liver underwent SWR to enhance graft suitability. Initial imaging revealed fatty liver with a fat fraction of 15.3% and elevated alanine aminotransferase. Volumetric analysis favored the left liver (left liver GRWR, 1.11; right liver GRWR, 2.40). Post-SWR imaging showed reduced liver volume and improved hepatic steatosis, leading to the selection of the right liver for transplantation (left liver GRWR, 0.79; right liver GRWR, 1.65). Successful LDLT was performed using the right liver graft. SWR programs can significantly impact donor liver quality and volume, influencing graft selection for LDLT. Re-evaluation of donor conditions, including hepatic steatosis and volumetry, at the time of surgery is crucial to optimize graft choices and improve post-transplant outcomes.

Keyword

Fatty liver; Living donors; Liver transplantation; Weight reduction programs; Factor analysis, volumetric