Fibroprogression and Cirrhosis Occurring in Living Liver Donor: First Case Report

Limited dead donor pool paved the way for living liver donation so that waitlist mortality could be reduced. With over two decades of experience in the East as well as in the West, right lobe adult-to-adult living donor liver transplantation has become an established intervention. The short-term surgical outcomes, complications and health-related quality of life are well known. There is dearth of data on long-term health of remnant liver of donors, especially after a decade of donation.

A 56-year-old lady who donated her right liver lobe 11 years back for her husband with end-stage liver disease. Recipient is doing well till date. She was incidentally found to have thrombocytopenia on follow-up. Her haematological evaluation was negative for blood dyscrasias. Further evaluation demonstrated biopsy-proven cirrhosis with endoscopic evidence of portal hypertension. Aetiological workup was done, which ruled out viral, autoimmune causes as well as Wilson's disease and hemochromatosis. This donor had gained weight post-donation with body mass index of 32.4 kg/m² and dyslipidaemia. The final diagnosis of fibro progression due to non-alcoholic fatty liver disease was made.

We report the first case of cirrhosis developing in a right lobe living liver donor. While selecting living liver donors, extensive evaluation is done to rule out all potential aetiologies remaining silent but later could lead on to chronic liver disease. Although all other aetiologies, which could induce inflammation and fibrosis, are ruled out at the time of donation, lifestyle liver disease, especially non-alcoholic fatty liver disease, can occur in remnant liver post-donation. This case underscores the importance of regular follow-up of liver donors.