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

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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.

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Availability of data and material

The data that support the findings of the present study are available within the article.

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Authors and Affiliations

  1. Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver & Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India

    Viniyendra Pamecha, Nilesh Sadashiv Patil, Kumaraswamy Parthasarathy, Piyush Kumar Sinha & Nihar Mohapatra

  2. Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India

    Archana Rastogi & Karthika Rudrakumar

  3. Department of Interventional Radiology, Institute of Liver & Biliary Sciences, New Delhi, India

    Amar Mukund

  4. Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India

    Ashok Chaudhary

  5. Department of Nutrition, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India

    Uma Kanal

Authors
  1. Viniyendra Pamecha
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  2. Nilesh Sadashiv Patil
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  3. Kumaraswamy Parthasarathy
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  4. Piyush Kumar Sinha
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Contributions

Study concept: Viniyendra Pamecha. Study design: Viniyendra Pamecha, Nilesh Patil, Piyush Kumar Sinha. Data collection: Kumaraswamy Parthasarathy, Nihar Mohapatra, Archana Rastogi, Karthika Rudrakumar, Ashok Choudhury, Amar Mukund, Uma Kanal. Analysis and interpretation of data: Nilesh Patil, Kumaraswamy Parthasarathy, Viniyendra Pamecha, Archana Rastogi.

Manuscript drafting: Nilesh Patil, Viniyendra Pamecha, Kumaraswamy Parthasarathy, Archana Rastogi. Critical revision of the manuscript for important intellectual content: Viniyendra Pamecha, Nilesh Patil.

Corresponding author

Correspondence to Viniyendra Pamecha.

Ethics declarations

Ethics approval

The study was approved by the Institutional Review Board (no. IEC/2020/81/NA01) of Institute of Liver and Biliary Sciences, New Delhi and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

The authors declare no competing interests.

Consent to participate

Informed consent was obtained from all individuals as a mandatory part of quality control in our hospital.

Consent for publication

All authors have read the final version of the article and have provided consent for the article to be published in Langenbeck’s Archives of Surgery.

Research registration unique identifying number (UIN)

1. Name of the registry: ClinicalTrials.gov. Registration: https://www.clinicaltrials.gov/

2. Unique identifying number or registration ID: NCT04571957.

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This paper was presented as an oral presentation at the 25th Annual Scientific Meeting of the Indian National Association for Study of The Liver at New Delhi, India, in August 2017.

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Cite this article

Pamecha, V., Patil, N.S., Parthasarathy, K. et al. Expanding donor pool for live donor liver transplantation: utilization of donors with non-alcoholic steatohepatitis after optimization. Langenbecks Arch Surg 407, 1575–1584 (2022). https://doi.org/10.1007/s00423-022-02444-5

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