Weight loss interventions in living donor liver transplantation as a tool in expanding the donor pool: A systematic review and metaanalysis  

作　　者：Sushrut Trakroo Nakul Bhardwaj Rajat Garg Jamak Modaresi Esfeh 

机构地区：[1]Department of Hospital Medicine,Cleveland Clinic,Cleveland,OH 44195,United States [2]Department of Internal Medicine,Cleveland Clinic,Cleveland,OH 44195,United States [3]Department of Gastroenterology and Transplant Hepatology,Cleveland Clinic,Cleveland,OH 44195,United States

出　　处：《World Journal of Gastroenterology》2021年第24期3682-3692,共11页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND With increasing rates of liver transplantation and a stagnant donor pool,the annual wait list removals have remained high.Living donor liver transplantation(LDLT)is an established modality in expanding the donor pool and is the primary method of liver donation in large parts of the world.Marginal living donors,including those with hepatic steatosis,have been used to expand the donor pool.However,due to negative effects of steatosis on graft and recipient outcomes,current practice excludes overweight or obese donors with more than 10%macro vesicular steatosis.This has limited a potentially important source to help expand the donor pool.Weight loss is known to improve or resolve steatosis and rapid weight loss with short-term interventions have been used to convert marginal donors to low-risk donors in a small series of studies.There is,however,a lack of a consensus driven standardized approach to such interventions.AIM To assess the available data on using weight loss interventions in potential living liver donors with steatotic livers and investigated the feasibility,efficacy,and safety of using such donors on the donor,graft and recipient outcomes.The principal objective was to assess if using such treated donor livers,could help expand the donor pool.METHODS We performed a comprehensive literature review and meta-analysis on studies examining the role of short-term weight loss interventions in potential living liver donors with hepatic steatosis with the aim of increasing liver donation rates and improving donor,graft,and recipient outcomes.RESULTS A total of 6 studies with 102 potential donors were included.Most subjects were males(71).All studies showed a significant reduction in body mass index postintervention with a mean difference of-2.08(-3.06,1.10,I2=78%).A significant reduction or resolution of hepatic steatosis was seen in 93 of the 102(91.2%).Comparison of pre-and post-intervention liver biopsies showed a significant reduction in steatosis with a mean difference of-21.22(-27.02,-15.43,I2=5

关 键 词：Living donor liver transplant Living liver donors Liver steatosis Weight loss interventions Donor outcomes Recipient outcomes 

分 类 号：R657.3[医药卫生—外科学]