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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Donor BMI >30 Is Not a Contraindication for Live Liver Donation.

M Knaak1,2, N Goldaracena1, A Doyle3

  • 1Department of Surgery, Multi Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
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Summary

Obesity is rising, impacting liver donation. This study found that donors with a body mass index (BMI) of 30 or higher, without liver steatosis, are suitable for living donor liver transplantation (LDLT).

Keywords:
clinical research/practicedonors and donation: livingliver transplantation/hepatologyliver transplantation: living donor

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Area of Science:

  • Hepatology
  • Transplantation Surgery
  • Obesity Medicine

Background:

  • Rising global obesity rates pose a challenge to the availability of living liver donors.
  • The adverse effects of graft steatosis on liver transplantation outcomes are established, but the impact of obesity without steatosis remains unclear.

Purpose of the Study:

  • To evaluate the outcomes of living donor liver transplantation (LDLT) using donors with a body mass index (BMI) ≥30 compared to those with BMI <30, specifically in the absence of hepatic steatosis.

Main Methods:

  • A retrospective analysis of 469 LDLT procedures between April 2000 and May 2014.
  • Donors were stratified based on BMI (<30 vs. ≥30), with exclusion of steatosis (>10%) in the higher BMI group via imaging and biopsy.
  • Outcomes compared included donor postoperative complications, recipient graft function (serum bilirubin, INR), and recipient complication rates.

Main Results:

  • Donors with BMI ≥30 (n=105) and BMI <30 (n=364) exhibited similar postoperative complication rates (2% vs. 3%) and hospital stays (6 days).
  • Recipient graft function, assessed by peak serum bilirubin and INR, was identical between the groups.
  • No significant differences were observed in recipient complication rates (25% vs. 20%) or hospital stays.

Conclusions:

  • Donors with a BMI ≥30 are not contraindicated for living donor liver transplantation (LDLT) provided that graft steatosis is absent.
  • This finding expands the potential donor pool for LDLT amidst increasing obesity prevalence.
  • Careful donor selection, excluding steatosis, is crucial for successful LDLT outcomes.