The impact of metabolic syndrome and prevalent liver disease on living donor liver transplantation: a pressing need to expand the pool

Organ shortage has been the ongoing obstacle to expanding liver transplantation worldwide. Living donor liver transplantation (LDLT) is hoped to improve this shortage. The aim of the present study is to analyze the impact of metabolic syndrome and prevalent liver disease on living donations. From July 2007 to May 2012, 1065 potential living donors were evaluated according to a stepwise evaluation protocol. The age of the worked-up donors ranged from 18 to 45 years. Only 190 (18 %) were accepted for donation, and 875 (82 %) were rejected. In total, 265 (24.9 %) potential donors were excluded because of either diabetes or a body mass index > 28. Some potential donors were excluded at initial screening because of incompatible blood groups (115; 10.8 %), social reasons (40; 3.8 %), or elevated liver enzymes (9; 1 %). Eighty-five (8 %) donors were excluded because of positive hepatitis serology. Steatosis resulted in the exclusion of 84 (8 %) donors. In addition, 80 (7.5 %) potential donors were rejected because of variations in biliary anatomy, and 20 (2 %) were rejected because of aberrant vascular anatomy. Rejection due to biliary-related aberrancy decreased significantly in the second half of our program (11 vs. 4 %, p = 0.001). In total, 110 (10.3 %) potential donors were rejected because of insufficient remnant volume (< 30 %) as determined by CT volumetry, whereas 24 (2.2 %) were rejected because of a graft-to-recipient body weight ratio less than 0.8 %. Metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.