4.5 Article

Noninvasive Risk Stratification for Nonalcoholic Fatty Liver Disease Among Living Liver Donor Candidates: A Proposed Algorithm

Journal

LIVER TRANSPLANTATION
Volume 28, Issue 4, Pages 670-677

Publisher

WILEY
DOI: 10.1002/lt.26365

Keywords

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Funding

  1. NIEHS [5P42ES010337]
  2. NCATS [5UL1TR001442]
  3. DOD PRCRP [W81XWH-18-2-0026]
  4. NIDDK [U01DK061734, R01DK106419, R01DK121378, R01DK124318, P30DK120515]
  5. NHLBI [P01HL147835]
  6. NIAAA [U01AA029019]

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Living donor liver transplantation (LDLT) has increased in the United States over the past decade in an effort to reduce waitlist mortality, but organ shortage remains an issue. The rise in nonalcoholic fatty liver disease (NAFLD) in the general population poses challenges for expanding the living liver donor pool. A clinical assessment algorithm that thoroughly evaluates for NAFLD and fibrosis is crucial for the safe expansion of LDLT.
To reduce waitlist mortality, living donor liver transplantation (LDLT) has increased over the past decade in the United States, but not at a rate sufficient to completely mitigate organ shortage. As a result, there are ongoing efforts to expand the living liver donor pool. Simultaneously, the prevalence of nonalcoholic fatty liver disease (NAFLD) in the general population has increased, which has significant implications on the pool of potential living liver donors. As such, a clinical assessment algorithm that exhaustively evaluates for NAFLD and fibrosis is critical to the safe expansion of LDLT. An ideal algorithm would employ safe and noninvasive methods, relying on liver biopsy only when necessary. While exclusion of NAFLD and fibrosis by noninvasive means is widely studied within the general population, there are no well-accepted guidelines for evaluation of living donors using these modalities. Here we review the current literature regarding noninvasive NALFD and fibrosis evaluation and propose a potential algorithm to apply these modalities for the selection of living liver donors.

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