Atasever Ahmet, Yazıcı Sinan Efe, Şahin Tolga, Yuzer Yıldıray
Department of General Surgery, Florence Nightingale Hospital Liver Transplantation Center, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey.
Florence Nightingale Hospital Liver Transplantation Center, Istanbul, Turkey.
Ann Transplant. 2025 May 27;30:e947772. doi: 10.12659/AOT.947772.
BACKGROUND Living donor liver transplantation (LDLT) faces increasing challenges due to the rising prevalence of hepatic steatosis among potential donors. Moderate steatosis (30-60%) is particularly problematic, often leading to donor exclusion and reducing the available donor pool. Preoperative interventions aiming to reduce hepatic fat content have emerged as a potential strategy, but data regarding their safety and efficacy remain limited. MATERIAL AND METHODS This retrospective, single-center study evaluated 34 living liver donors between June 2023 and August 2024. Fourteen donors received preoperative treatment for moderate hepatic steatosis, while 20 donors with mild or no steatosis served as controls. Pre- and post-treatment assessments included body mass index (BMI), liver fat assessment via computed tomography (CT), liver function tests, and perioperative outcomes. RESULTS Preoperative treatment significantly reduced hepatic fat content, with all treated donors achieving steatosis levels below 30% (P<0.001). BMI and GGT levels also decreased significantly after treatment (P=0.01 and P=0.04, respectively). Postoperative liver function, intensive care unit stay, and hospital discharge times were comparable between the treated and control groups (P>0.05). No donor experienced serious complications during the early postoperative period or the first year of follow-up. All donors maintained satisfactory graft and remnant liver function, and no treatment-related adverse events were observed. CONCLUSIONS Preoperative management of moderate hepatic steatosis in living liver donors is effective in reducing liver fat to acceptable levels without compromising donor safety. This approach offers a promising strategy to expand the LDLT donor pool. Further large-scale, multicenter studies with extended follow-up are necessary to validate these findings.
背景 由于潜在供体中肝脂肪变性的患病率不断上升，活体肝移植（LDLT）面临着越来越多的挑战。中度脂肪变性（30%-60%）尤其成问题，常常导致供体被排除，减少了可用的供体库。旨在降低肝脏脂肪含量的术前干预措施已成为一种潜在策略，但关于其安全性和有效性的数据仍然有限。
材料与方法 这项回顾性单中心研究评估了2023年6月至2024年8月期间的34名活体肝供体。14名供体接受了中度肝脂肪变性的术前治疗，而20名轻度或无脂肪变性的供体作为对照。治疗前后的评估包括体重指数（BMI）、通过计算机断层扫描（CT）进行的肝脏脂肪评估、肝功能测试和围手术期结果。
结果 术前治疗显著降低了肝脏脂肪含量，所有接受治疗的供体脂肪变性水平均降至30%以下（P<0.001）。治疗后BMI和γ-谷氨酰转移酶（GGT）水平也显著下降（分别为P=0.01和P=0.04）。治疗组和对照组的术后肝功能、重症监护病房住院时间和出院时间相当（P>0.05）。在术后早期或随访的第一年，没有供体发生严重并发症。所有供体的移植物和残余肝功能均保持良好，未观察到与治疗相关的不良事件。
结论 对活体肝供体的中度肝脂肪变性进行术前管理可有效将肝脏脂肪降低至可接受水平，且不影响供体安全。这种方法为扩大LDLT供体库提供了一种有前景的策略。需要进一步进行大规模、多中心研究并延长随访时间以验证这些发现。
