Impact of short-term weight reduction program for steatotic graft or high BMI donor on the outcome of living-donor liver transplantation

초록

Background: Steatotic liver graft in the living donor liver transplantation could adversely affect graft recovery, including a higher incidence of early allograft dysfunction, biliary strictures, and worse graft survival. This study evaluated the impact of rapid weight reduction for steatotic graft on the outcome of living-donor liver transplantation. Methods: Consecutive patients who underwent living-donor liver transplantation were enrolled in this study. The study cohort comprised 17 patients who reduced weight to improve their steatotic liver (WR group) and 128 patients who did not (non-WR group). Potential donors reduced weight if the BMI was 30 kg/m2 or higher or the graft steatosis was 20% or higher. Results: The median BMI and graft steatosis before weight reduction was 30.8kg/m2 (range 22.4–43.4) and 27.0% [8.5–80.0]. The duration of weight reduction was 72 (30–134) days. After weight reduction, the BMI and graft steatosis in the WR group were still higher compared to the non-WR group (27.7 [20.0–37.2] vs. 23.4 [16.7–33.0], P=0.002, and 7.0 [5.0–25.0] vs. 3.0 [0–30.0], P<0.001). In donor outcome, the incidence of post-hepatectomy liver failure and complications above Clavien–Dindo grade IIIA were not different between the groups (3 [17.6%] vs. 11 [8.6%], P=0.214, and 1 [5.9%] vs. 2 [1.6%], P=0.314). In recipient outcome, the incidence of biliary complication was not different between the WR and non-WR group (5 [29.4%] vs. 27 [21.1%], P=0.533). Early allograft dysfunction and 90-day mortality only occurred in the non-WR group (both 4 [3.1%], P=1.000). Conclusions: Active utilization of short-term weight reduction programs for selected donors with high BMI and steatotic grafts could lead to acceptable clinical outcomes for both donors and recipients. Furthermore, it could turn marginal donors into low-risk donors and expand the donor pool. Future prospective large-scale studies are needed.