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The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool

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Abstract

Background and aims

Organ shortage has been the ongoing obstacle to expanding liver transplantation worldwide. Living donor liver transplantation (LDLT) is hoped to improve this shortage. The aim of the present study is to analyze the impact of metabolic syndrome and prevalent liver disease on living donations.

Methods

From July 2007 to May 2012, 1065 potential living donors were evaluated according to a stepwise evaluation protocol. The age of the worked-up donors ranged from 18 to 45 years.

Results

Only 190 (18 %) were accepted for donation, and 875 (82 %) were rejected. In total, 265 (24.9 %) potential donors were excluded because of either diabetes or a body mass index >28. Some potential donors were excluded at initial screening because of incompatible blood groups (115; 10.8 %), social reasons (40; 3.8 %), or elevated liver enzymes (9; 1 %). Eighty-five (8 %) donors were excluded because of positive hepatitis serology. Steatosis resulted in the exclusion of 84 (8 %) donors. In addition, 80 (7.5 %) potential donors were rejected because of variations in biliary anatomy, and 20 (2 %) were rejected because of aberrant vascular anatomy. Rejection due to biliary-related aberrancy decreased significantly in the second half of our program (11 vs. 4 %, p = 0.001). In total, 110 (10.3 %) potential donors were rejected because of insufficient remnant volume (<30 %) as determined by CT volumetry, whereas 24 (2.2 %) were rejected because of a graft-to-recipient body weight ratio less than 0.8 %.

Conclusion

Metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.

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References

  1. Hjartåker A, Langseth H, Weiderpass E. Obesity and diabetes epidemics: cancer repercussions. Adv Exp Med Biol 2008;630:72–93

    Article  PubMed  Google Scholar 

  2. Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 2012;307(5):491–497

    Article  PubMed  Google Scholar 

  3. Memish ZA, El Bcheraoui C, Tuffaha M, et al. Obesity and associated factors—kingdom of Saudi Arabia, 2013. Prev Chronic Dis 2014;9(11):E174

    Google Scholar 

  4. Al-Othaimeen AI, Al-Nozha M, Osman AK. Obesity: an emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey. East Mediterr Health J 2007;13(2):441–448

    CAS  PubMed  Google Scholar 

  5. Warsy AS, el-Hazmi MA. Diabetes mellitus, hypertension, and obesity—common multifactorial disorders in Saudis. East Mediterr Health J 1999;5(6):1236–1242

  6. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;25(9):88

    Article  Google Scholar 

  7. Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology 2014;59(6):2188–2195

    Article  PubMed  Google Scholar 

  8. Singal AK, Guturu P, Hmoud B, et al. Evolving frequency and outcomes of liver transplantation based on etiology of liver disease. Transplantation 2013;95(5):755–760

    Article  PubMed  Google Scholar 

  9. Al MI, Abaalkhail FA, Bahili HA, et al. Liver transplantation at KFSHRC: achievement and challenges. Ann Saudi Med 2014;34(2):103–106

  10. Al-Faleh FZ. Hepatitis B infection in Saudi Arabia. Ann Saudi Med 1988;8:474–480

    Google Scholar 

  11. Abaalkhail F, Elsiesy H, Alomair A, et al. SASLT practice guidelines for the management of hepatitis B virus.Saudi J Gastroenterol 2014;20(1):5–25

  12. Allam N, Al Saghier M, El Sheikh Y, et al. Clinical outcomes for Saudi and Egyptian patients receiving deceased donor liver transplantation in China. Am J Transplant 2010;10(8):1834–1841

    Article  CAS  PubMed  Google Scholar 

  13. Park SH, Kim PN, Kim KW, Lee SW, Yoon SE, Park SW, et al. Macrovesicularhepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 2006;239:105–112

    Article  PubMed  Google Scholar 

  14. Park YS, Park SH, Lee SS, Kim DY, Shin YM, Lee W, et al. Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology 2011;258:760–766

    Article  PubMed  Google Scholar 

  15. Ringe B, Strong RW. The dilemma of living liver donor death: to report or not toreport? Transplantation 2008;85(6):790–793

    Article  PubMed  Google Scholar 

  16. Ghobrial RM, Freise CE, Trotter JF, et al. Donor morbidity after living donation for liver transplantation. Gastroenterology 2008;135(2):468–476

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shah SA, Levy GA, Adcock LD, et al. Adult-to-adult living donor liver transplantation. Can J Gastroenterol 2006;20(5):339–343

    PubMed  PubMed Central  Google Scholar 

  18. Abdullah K, Abdeldayem H, Salama IA, et al. Retrospective analysis of the causes of rejection of potential donors for living related liver transplantation. Hepatol Int 2007;1(4):431–436

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sobhonslidsuk A, Intaraprasong P, Tongprasert S. Evaluation of donors for living donor liver transplantation (LDLT). J Med Assoc Thai 2010;93(5):637–641

    PubMed  Google Scholar 

  20. Trotter JF, Wachs M, Trouillot T, et al. Evaluation of 100 patients for living donor liver transplantation. Liver Transpl 2000;6(3):290–295

    Article  CAS  PubMed  Google Scholar 

  21. El-Meteini M, Dabbous H, Sakr M, et al. Donor rejection before living donor liver transplantation: causes and cost effective analysis in an egyptian transplant center. Hepat Mon 2014;14(1):e13703

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wahab MA, Hamed H, Salah T, et al. Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience. World J Gastroenterol 2014;20(37):13607–13614

    Article  PubMed  PubMed Central  Google Scholar 

  23. Valentin-Gamazo C, Malago M, Karliova M, et al. Experience after the evaluation of 700 potential donors for living donor liver transplantation in a single center. Liver Transpl 2004;10(9):1087–1096

    Article  PubMed  Google Scholar 

  24. Liu B, Yan LN, Wang WT, et al. Clinical study on safety of adult-to-adult living donor liver transplantation in both donors and recipients. World J Gastroenterol 2007;13(6):955–959

    Article  PubMed  PubMed Central  Google Scholar 

  25. AlFaleh F, Alshehri S, Alansari S, et al. Long-term protection of hepatitis B vaccine 18 years after vaccination. J Infect 2008;57(5):404–409

    Article  PubMed  Google Scholar 

  26. Abdo AA, Sanai FM, Al-Faleh FZ. Epidemiology of viral hepatitis in Saudi Arabia: are we off the hook? Saudi J Gastroenterol 2012;18(6):349–357

  27. Alawaidib FM, O’Brien SJ. Is there a need to include HIV, HBV, and HCV viruses in the Saudi premarital screening program on the basis of their prevalence and transmission risk factors? J Epidemiol Community Health 2010;64(11):989–997

    Article  Google Scholar 

  28. Lee KW, Lee DS, Lee HH, et al. Prevention of de novo hepatitis B infection from HbcAb-positive donors in living donor liver transplantation. Transpl Proc 2004;36(8):2311–2312

    Article  CAS  Google Scholar 

  29. Jain A, Orloff M, Abt P, et al. Use of hepatitis B core antibody-positive liver allograft in hepatitis C virus-positive and -negative recipients with use of short course of hepatitis B immunoglobulin and Lamivudine. Transplant Proc 2005;37(7):3187–3189

    Article  CAS  PubMed  Google Scholar 

  30. Vizzini G, Gruttadauria S, Volpes R, et al. Lamivudine monoprophylaxis for de novo HBV infection in HBsAg-negative recipients with HBcAb-positive liver grafts. Clin Transpl 2011;25(1):E77–E81

  31. Yu S, Yu J, Zhang W, et al. Safe use of liver grafts from hepatitis B surface antigen positive donors in liver transplantation. J Hepatol 2014;61(4):809–815

    Article  CAS  PubMed  Google Scholar 

  32. Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis 2008;28(4):339–350

    Article  PubMed  Google Scholar 

  33. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34(3):274–285

    Article  CAS  PubMed  Google Scholar 

  34. Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, et al. Diabetes mellitus in Saudi Arabia. Saudi Med J 2004;25(11):1603–1610

    PubMed  Google Scholar 

  35. Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, et al. Obesity in Saudi Arabia. Saudi Med J 2005;26(5):824–829

    PubMed  Google Scholar 

  36. Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 2005;128(7):1898–1906

    Article  PubMed  Google Scholar 

  37. Frankel WL, Tranovich JG, Salter L, Bumgardner G, Baker P. The optimal number of donor biopsy sites to evaluate liver histology for transplantation. Liver Transpl 2002;8(11):1044–1050

    Article  PubMed  Google Scholar 

  38. Noworolski SM, Lam MM, Merriman RB, Ferrell L, Qayyum A. Liver steatosis: concordance of MR imaging and MR spectroscopic data with histologic grade. Radiolog 2012;264(1):88–96

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hegab B, Abdelfattah MR, Azzam A, Mohamed H, Al Hamoudi W, Alkhail FA. Day-of-surgery rejection of donors in living donor liver transplantation. World J Hepatol 2012;4(11):299–304

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wang SF, Huang ZY, Chen XP. Biliary complications after living donor liver transplantation. Liver Transpl 2011;17(10):1127–1136

    Article  PubMed  Google Scholar 

  41. Wertheim JA, Petrowsky H, Saab S, et al. Major challenges limiting liver transplantation in the United States. Am J Transpl 2011;11(9):1773–1784

    Article  CAS  Google Scholar 

  42. Tsang LL, Chen CL, Huang TL, et al. Preoperative imaging evaluation of potential living liver donors: reasons for exclusion from donation in adult living donor liver transplantation. Transpl Proc 2008;40(8):2460–2462

    Article  Google Scholar 

  43. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successful living donor liver transplantation. Transplantation 1999;68(8):1112–1116

    Article  CAS  PubMed  Google Scholar 

  44. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation 1999;67(2):321–327

    Article  CAS  PubMed  Google Scholar 

  45. Hwang S, Lee SG, Jang SJ, et al. The effect of donor weight reduction on hepatic steatosis for living donor liver transplantation. Liver Transpl 2004;10(6):721–725

    Article  PubMed  Google Scholar 

  46. Moss J, Lapointe-Rudow D, Renz JF, et al. Select utilization of obese donors in living donor liver transplantation: implications for the donor pool. Am J Transpl 2005;5:2974–2981

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, P.O BOX 2454, Riyadh, 11451, Saudi Arabia

    Waleed Al-hamoudi & Abdurahman Bendahmash

  2. Department of Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, P.O. BOX 3354, Riyadh, 11211, Saudi Arabia

    Waleed Al-hamoudi, Faisal Abaalkhail, Bassem Hegab, Yasser Elsheikh, Hamad Al-bahili, Nasser Almasri, Mohammed Al-sofayan, Saleh Alabbad, Mohammed Al-Sebayel, Dieter Broering & Hussien Elsiesy

  3. Hepatology Department, National Liver Institute, Menoufeya University, Menoufeya, Egypt

    Naglaa Allam

Authors
  1. Waleed Al-hamoudi
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  2. Faisal Abaalkhail
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  13. Hussien Elsiesy
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Corresponding author

Correspondence to Waleed Al-hamoudi.

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Conflict of interest

Waleed Al-hamoudi, Faisal Abaalkhail, Abdurahman Bendahmash, Naglaa Allam, Bassem Hegab, Yasser Elsheikh, Hamad Al-bahili, Nasser Almasri, Mohammed Al-sofayan, Saleh Alabbad, Mohammed Al-sebayel, Dieter Broering, and Hussien Elsiesy declare that they have no conflict of interest.

Ethical standards

The study was approved by our Institutional Review Board and conformed to the ethical guidelines of the Declaration of Helsinki.

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Al-hamoudi, W., Abaalkhail, F., Bendahmash, A. et al. The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool. Hepatol Int 10, 347–354 (2016). https://doi.org/10.1007/s12072-015-9664-7

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  • DOI: https://doi.org/10.1007/s12072-015-9664-7

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