Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2021; 27(24): 3682-3692
Published online Jun 28, 2021. doi: 10.3748/wjg.v27.i24.3682
Weight loss interventions in living donor liver transplantation as a tool in expanding the donor pool: A systematic review and meta-analysis
Sushrut Trakroo, Nakul Bhardwaj, Rajat Garg, Jamak Modaresi Esfeh
Sushrut Trakroo, Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Nakul Bhardwaj, Rajat Garg, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Jamak Modaresi Esfeh, Department of Gastroenterology and Transplant Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Trakroo S designed the study, did the data acquisition, helped analyzed and interpreted data, drafted and made critical revisions to manuscript content and made final revisions before publication; Bhardwaj N helped analyze the data, drafted the manuscript, made critical revisions to the manuscript and helped make final revisions before publication; Garg R substantially contributed to data analysis and interpretation, made critical revisions to the manuscript and helped in the final approval of article before publication; Modaresi Esfeh J conceptualized the study, designed the study, helped with drafting of the article, made critical revisions to the content of manuscript, helped with data analysis and did the final approval of the version of the article before publication.
Conflict-of-interest statement: There are no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jamak Modaresi Esfeh, MD, Staff Physician, Department of Gastroenterology and Transplant Hepatology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. modarej@ccf.org
Received: January 24, 2021
Peer-review started: January 24, 2021
First decision: February 23, 2021
Revised: March 8, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: June 28, 2021
ARTICLE HIGHLIGHTS
Research background

The rates of liver transplantation having increasing but the donor pool has largely remained stagnant leading to high removals from liver transplant waitlists. Living donor liver transplantation (LDLT) using fatty liver could potentially be used to expand the donor pool. However, due to negative effects of steatosis on Graft and recipient outcomes, current practice is to exclude overweight or obese donors with steatosis livers. Data on feasibility, efficacy, and safety of using weight loss interventions marginal donors to low-risk donors is lacking. The aim of the study was to evaluate the feasibility safety and efficacy of short-term weight loss interventions in converting marginal living liver donors to low-risk donors.

Research motivation

Data on safety, efficacy and donor, graft and recipient outcomes when using short term weight loss interventions to convert marginal steatotic liver grafts in LDLT, to low-risk grafts, is lacking. With continuing shortage of organs for transplantation, we looked into the safety and efficacy of using treated steatotic donors, for LDLT.

Research objectives

We did a meta-analysis on the feasibility, safety, and efficacy of weight loss interventions in converting marginal living liver donors to low-risk donors and analyzed the perioperative donor, graft and recipient outcomes.

Research methods

We performed a systematic 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.

Research results

A total of 6 studies with 102 potential donors were included. Most subjects were males (n = 71). All studies showed a significant reduction in body mass index post-intervention 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 = 56%). The liver donation rates post-intervention was 88.5 (74.5, 95.3, I2 = 42%). All donors who did not undergo LDLT had either recipient reasons or had fibrosis/steatohepatitis on post intervention biopsies. Post-operative biliary complications in the intervention group were not significantly different compared to controls with an odds ratio of 0.96 [(0.14, 6.69), I2 = 0]. The overall post-operative donor, graft, and recipient outcomes in treated donors were not significantly different compared to donors with no steatosis.

Research conclusions

Our study has shown that using liver grafts from potential living liver donors with hepatic steatosis undergoing short term weight loss interventions, have comparable donor, graft, and recipient outcomes, to donors with no hepatic steatosis.

Research perspectives

Use of appropriate short term weight loss interventions in living liver donors is a feasible, safe, and effective tool in turning marginal donors with liver steatosis to low-risk donors and therefore can help in expanding the donor pool.