| Theme |
Debatable Issues in Living-Donor Liver Transplantation |
| Title |
Fatty Change in Donors for Living Donor Liver Transplantation |
| Author |
Yasuhiro Fujimoto |
Department of Transplantation Surgery, Nagoya University Hospital |
| Author |
Koji Yamamoto |
1st Department of Surgery, Ehime University School of Medicine |
| Author |
Hidekazu Yamamoto |
Department of Transplantation Surgery, Nagoya University Hospital |
| Author |
Yasutsugu Takada |
Department of Transplantation Surgery, Kyoto University Hospital |
| Author |
Tetsuya Kiuchi |
Department of Transplantation Surgery, Nagoya University Hospital |
| Author |
Koichi Tanaka |
Institute of Biomedical Research and Innovation |
| [ Summary ] |
With living-donor transplantation, donor safety is of vital importance. Since one donor death was reported, in Japan, with the donor probably having NASH (non alcoholic steatohepatitis), those with NASH should be ruled out as donor candidates for living-donor liver transplantation. Thorough evaluation of the medical history of potential donors is mandatory in cases involving diabetes mellitus, hypertension, obesity, hyperlipidemia, or hyperuricemia, in which there are indications of insulin intolerance. In addition, a family history of cryptogenic liver cirrhosis may be attributable to a previous NASH condition and should be seriously considered, since NASH is thought to have familial or inherited components. If a potential donor is diagnosed as having steatosis by use of ultrasounds and / or CAT scans (Liver / Spleen ratio with plain CT less than 1.2 is compatible with macrovesicular steatosis over 30 %), insulin intolerance should be ruled out through HOMA-IR (Homeostasis Model Analysis for Insulin Resistance). If insulin intolerance is suspected, liver biopsy should be undertaken to exclude NASH. NAFLD (non alcoholic fatty liver disease) or NASH conditions can be improved by gradual, controlled diet. However, if the patient loses body weight too quickly, there may be a progression toward fibrosis. |