Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living-donor liver transplantation: A single-center experience

Objectives: Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme. Methods: This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019. Results: Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 +/- 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 +/- 4.0 kg/m2; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan (R), we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD. Conclusion: NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia. (c) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Automated summary

The study revealed that obesity and NAFLD are significant challenges to the emerging LDLT program in Malaysia, with 74.5% of potential donors being not utilized due to these issues. Unsuitable donors typically have higher BMI, CAP scores, and rates of dyslipidaemia and NAFLD compared to suitable donors.