Departments of Liver Transplant and Hepato-Pancreato-Biliary Surgery.
Clinical nutrition.
Ann Surg. 2023 Sep 1;278(3):e430-e439. doi: 10.1097/SLA.0000000000005836. Epub 2023 Mar 13.
The aim of the current randomized control trial was to assess the efficacy of donor lifestyle optimization on liver regeneration and outcome following live donor liver transplantation.
Live liver donors (LLDs) who were fit with no or minimal steatosis were randomized to receive either a customized low-calorie diet with calorie intake equalling their basal requirement along with exercise for 2 weeks before surgery versus to continue their normal routine lifestyle. Primary objectives were the difference in the day of normalization of serum bilirubin and PT-International normalized ratio and the percentage growth of the liver at postoperative day 7 and 14. Secondary objectives were differences in intraoperative liver biopsy, liver-regeneration markers, blood loss, hospital stay, the complication rate in LLDs, and rates of early graft dysfunction (EGD) in recipients.
Sixty-two consecutive LLDs were randomized (28 in intervention vs. 34 in control). Baseline parameters and graft parameters were similar in both groups. LLDs in the intervention arm had significantly decreased calorie intake ( P <0.005), abdominal girth ( P <0.005), BMI ( P =0.05), and weight ( P <0.0005). The mean blood loss ( P =0.038), day of normalization of bilirubin ( P =0.005) and International normalized ratio ( P =0.061), postoperative peak aspartate transaminase ( P =0.003), Alanine transaminase ( P =0.025), and steatosis ( P <0.005) were significantly less in the intervention group. There was significantly higher volume regeneration ( P =0.03) in donors in the intervention arm. The levels of TNF-α, IL-6, and IL-10 levels were significantly higher, while the TGF-β level was lower in donors in the intervention group. The rate of EGD was significantly higher in recipients in the control group ( P =0.043).
Lifestyle optimization of LLD is simple to comply with, improves liver regeneration in LLDs, and decreases EGD in recipients, thus can enhance donor safety and outcomes in live donor liver transplantation.
本随机对照试验的目的是评估供体生活方式优化对活体肝移植后肝脏再生和结局的疗效。
适合接受活体肝移植且无或仅有轻微脂肪变性的活体肝供体（LLD）被随机分为两组，一组在术前 2 周接受低热量饮食和与基础需求相等的热量摄入，并进行运动，另一组继续保持正常生活方式。主要目标是血清胆红素和国际标准化比值正常化日以及术后第 7 天和第 14 天肝脏生长百分比的差异。次要目标是肝活检、肝再生标志物、失血量、住院时间、LLD 的并发症发生率以及受体早期移植物功能障碍（EGD）的发生率的差异。
连续 62 例 LLD 被随机分组（干预组 28 例，对照组 34 例）。两组的基线参数和供体参数相似。干预组的 LLD 热量摄入明显减少（P<0.005），腹围（P<0.005）、BMI（P=0.05）和体重（P<0.0005）。平均失血量（P=0.038）、胆红素正常化日（P=0.005）和国际标准化比值（P=0.061）、术后天峰天门冬氨酸转氨酶（P=0.003）、丙氨酸转氨酶（P=0.025）和脂肪变性（P<0.005）明显低于对照组。干预组供体的体积再生明显更高（P=0.03）。干预组供体的 TNF-α、IL-6 和 IL-10 水平明显升高，而 TGF-β 水平明显降低。对照组受体的 EGD 发生率明显更高（P=0.043）。
LLD 的生活方式优化简单易行，可改善 LLD 的肝再生，降低受体的 EGD 发生率，从而提高供体的安全性和活体肝移植的效果。
