Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes?

Shohei Yoshiya; Shinji Itoh; Takeo Toshima; Takuma Izumi; Norifumi Iseda; Yuriko Tsutsui; Katsuya Toshida; Yuki Nakayama; Takuma Ishikawa; Yasushi Tanaka; Mizuki Ninomiya; Tomoharu Yoshizumi

doi:10.1016/j.gassur.2024.04.010

Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes?

J Gastrointest Surg. 2024 Apr 15:S1091-255X(24)00411-6. doi: 10.1016/j.gassur.2024.04.010. Online ahead of print.

Affiliations

¹ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: yoshiya.shohei.064@m.kyushu-u.ac.jp.
² Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

PMID: 38631611
DOI: 10.1016/j.gassur.2024.04.010

Abstract

Purpose: Although the incidence of recipients and donors with overweight and obesity is increasing worldwide, few reports have focused on outcomes of preoperative weight reduction (WR) in living-donor liver transplantation (LDLT). Therefore, we examined the outcomes and the impact of WR on the postoperative course.

Methods: We analyzed 217 consecutive LDLT procedures performed from 2017 to 2022. We divided the recipients and donors into a WR group and non-WR group.

Results: Twenty-two recipients (10.1%) achieved WR (preoperative recipient WR [RWR] group), reducing their weight by 6.8% ± 6.0% within 2.2 ± 1.4 months with a significant decrease in body mass index (BMI) (P < .0001). The RWR group showed no significant differences in short-term postoperative outcomes (operative factors, postoperative liver function tests, amount of ascites, and morbidity) or in the graft survival rate as a long-term outcome (P = .24) compared with the non-RWR group. Forty-one donors (18.9%) achieved WR (preoperative donor WR [DWR] group), reducing their weight by 9.7% ± 6.3% within 3.2 ± 5.8 months with a significant decrease in BMI (P < .0001). Compared with the non-DWR group, the DWR group showed no significant differences in short-term postoperative outcomes between themselves and recipients or in the graft survival rate (P = .49). Furthermore, WR resulted in an increase to 32 donor-eligible and 6 recipient-eligible patients.

Conclusion: WR in LDLT recipients and donors had no harmful effect on postoperative outcomes and should lead to increase recipients' chance of undergoing LDLT and to expand the donor pool.

Keywords: Donor weight reduction; Living-donor liver transplantation; Postoperative outcomes; Preoperative weight reduction; Recipient weight reduction.