Goto Ryoichi, Kawamura Norio, Watanabe Masaaki, Ganchiku Yoshikazu, Nagatsu Akihisa, Okada Kazufumi, Ito Yoichi M, Kamiyama Toshiya, Shimamura Tsuyoshi, Taketomi Akinobu
Department of Gastroenterological Surgery I Hokkaido University Graduate School of Medicine Sapporo Japan.
Department of Transplant Surgery Hokkaido University Graduate School of Medicine Sapporo Japan.
Ann Gastroenterol Surg. 2023 Feb 2;7(4):645-653. doi: 10.1002/ags3.12658. eCollection 2023 Jul.
Approximately 30 years have passed since the first experience of living donor liver transplantation. The time to evaluate the long-term safety of living donors has been fulfilled. Meanwhile, nonalcoholic fatty liver disease is increasingly common and a critical problem. The aim of this study was to evaluate the safety of living donor, focusing on fatty liver postdonation hepatectomy.
Living donors ( = 212, 1997-2019) were evaluated by computed tomography (CT) at >1-year postdonation. A liver to spleen (L/S) ratio of <1.1 was defined as fatty liver.
Among 212 living liver donors, 30 (14.2%) detected fatty liver at 5.3 ± 4.2 years postdonation. The cumulative incidence rates of fatty liver were 3.1%, 12.1%, 22.1%, and 27.7% at 2, 5, 10, and 15 years postdonation, respectively. Of 30 subjects who developed fatty liver, 18 (60%) displayed a severe steatosis (L/S ratio <0.9). Five (16.7%) had a prior history of excessive alcohol abuse. More than 30% developed metabolic syndrome including obesity, hyperlipidemia, and diabetes. Although six (20%) had a Fib-4 index of >1.3, which included a case with a Fib-4 index of >2.67, no significant increased Fib-4 index was observed in the subjects with fatty liver as compared to those without fatty liver ( 0.66). The independent predictive risk factors for developing fatty liver were male sex, pediatric recipient, and higher body mass index (>25) at donation.
Living donors with risk factors for developing fatty liver should be carefully followed-up for the prevention and management of metabolic syndrome.
自首例活体肝移植手术开展至今已过去约30年。评估活体供者长期安全性的时机已经成熟。与此同时，非酒精性脂肪性肝病日益常见且成为一个关键问题。本研究旨在评估活体供者的安全性，重点关注供肝切除术后的脂肪肝情况。
对212例活体供者（1997年至2019年）在供肝切除术后1年以上进行计算机断层扫描（CT）评估。肝脏与脾脏（L/S）比值<1.1被定义为脂肪肝。
在212例活体肝供者中，30例（14.2%）在供肝切除术后5.3±4.2年被检测出患有脂肪肝。供肝切除术后2年、5年、10年和15年脂肪肝的累积发病率分别为3.1%、12.1%、22.1%和27.7%。在30例发生脂肪肝的受试者中，18例（60%）表现为重度脂肪变性（L/S比值<0.9）。5例（16.7%）有过量饮酒史。超过30%的人出现了包括肥胖、高脂血症和糖尿病在内的代谢综合征。尽管6例（20%）的Fib-4指数>1.3，其中1例Fib-4指数>2.67，但与无脂肪肝的受试者相比，脂肪肝受试者的Fib-4指数未观察到显著升高（P=0.66）。发生脂肪肝的独立预测风险因素为男性、儿童受者以及供肝时较高的体重指数（>25）。
对于有发生脂肪肝风险因素的活体供者，应密切随访，以预防和管理代谢综合征。
