Hepatic steatosis is a major concern in living donor liver transplantation. Factors affecting hepatic functional status after a donor right hepatectomy (with the middle hepatic vein included in the graft) with a focus on changes owing to steatosis were retrospectively studied.
Methods
Donors (n= 325) were categorized into three groups: G0 (no steatosis, n= 178), G1 (< = 10% steatosis, n= 128) and G2 (>10% steatosis, n= 19). Donors with >20% steatosis were excluded. Changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin levels and prothrombin time (PT) were assessed. Factors predicting steatosis were also assessed. A liver biopsy was performed on selected donors.
Results
The ALT level rose until day 3 in G1 and day 6 in G2 (P < 0.05). The AST level rose until day 7 in G2 (P < 0.05) but stayed unchanged in G1. The bilirubin level was higher only on day 1 in G2 (P < 0.05). By day 30, no significant difference between any groups was noted. Receiver-operating characteristic (ROC) area under the curve for body mass index (BMI) on predicting steatosis was 0.75 [confidence interval (CI) = 69–80]. Among donors with a BMI > 23.5 kg/m2, 75% had steatosis. Five donors had >20% steatosis and were not assessed.
Conclusion
Using a liver with up to 20% steatosis in right liver donation, even if the middle hepatic vein is included in the graft, is safe. For Asian donors, a BMI > 23.5 kg/m2 is a guide in deciding whether to perform a liver biopsy for steatosis.
Keywords
fatty change
living donor
liver transplantation
donor hepatectomy
steatotic donor
body mass index
Cited by (0)
The abstract of this article was presented at the 21st Conference of the Asian Pacific Association for the Study of the Liver, Bangkok, 17 to 20 February 2011.
