Overweight patients are more susceptible for acute liver failure.

BACKGROUND/AIMS: To determine a potential correlation of gender, age, and/or body mass index (BMI) with the development of acute-on-chronic liver failure (AOC). METHODOLOGY: A retrospective 2.5-year study employed 34 patients (65% females and 35% males, aged 37.9 +/- 12.6 years) fulfilling established criteria for acute liver failure (ALF). Patients were subdivided into ALF (n = 18) and AOC (n = 16) groups, according to a history of prior chronic liver disease. Causes of liver failure included drug toxicity (52.9%), viral hepatitis (26.5%), and acute excessive ethanol abuse (11.8%). all anamneses were thoroughly reviewed. Throughout the course of the study, the patients were monitored for established clinical signs and laboratory parameters indicating acute liver injury. Gender, age, and BMI were correlated with the clinical outcome. RESULTS: Twelve patients (35.3%) received an orthotopic liver allograft, with one re-transplantation. Six patients (17.6%), including two transplanted individuals, died in the course of the study. Of all parameters evaluated, BMIs were significantly higher in AOC vs. ALF (p < 0.002), revealing values of > 25 in 62.5% of the AOC patients. When subjected to acute risk factors, elevated BMI clearly coincided with a higher rate of AOC. Importantly, half of all patients initially classified as ALF by employing current criteria thus suffered from AOC coinciding with increased mortality. CONCLUSIONS: Generally, these results call for a reduction of the BMI. Specifically, our findings argue for a closer BMI monitoring of patients at risk of developing chronic liver disease.

Experience after the evaluation of 700 potential donors for living donor liver transplantation in a single center.

Adequate selection of donors is a major prerequisite for living donor liver transplantation (LDLT). Few centers report on the entire number of potential donors considered or rejected for living donation. From April 1998 to July 2003, a total of 111 living donor liver transplantations were performed at our institution, with 622 potential donors for 297 adult recipients and 78 potential donors for 52 pediatric recipients evaluated. In the adult group, only 89 (14%) potential donors were considered suitable, with a total of 533 (86%) potential donors rejected. Of these, 67% were excluded either at initial screening or during the first and second steps of the evaluation procedure. In 31% of all cases, the evaluation of donors was canceled because of recipient issues. In the pediatric group, 22 (28%) donors were selected, with the other 56 (72%) rejected. Costs of the complete evaluation process accounted for 4,589 Euro (Euro) per donor. The evaluation of a potential living donor is a complex and expensive process. We present the results on the evaluation of the largest group of potential donors for adults reported in the literature. Only 14% of potential donors in our series were considered suitable candidates. It has not yet been established who should cover the expenses of the evaluation of all rejected donors. In conclusion, all efforts should be made in order to develop an effective screening protocol for the evaluation of donors with the aim of saving time and resources for a liver transplantation program.

Living-related liver transplantation from the view of the donor: a 1-year follow-up survey.

BACKGROUND: In the past, follow-up surveys for living-related liver transplantation (LRLT) mainly focused on the medical outcome of recipients and donors. In this survey the prevalence of personal, familial, or economic problems of the donors and changes of quality of life after donation were studied. METHODS: Questionnaires were sent to 24 donors after right hepatectomy for LRLT (response 92%). The modified EUROTOLD (European Multicenter Study of Transplantation Using Living Donors) questionnaire was used to inquire about the decision-making process, family problems, and economic problems related to the donation. Global quality of life was measured with the SF-36 Health Survey. RESULTS: For most donors the decision to donate was easy or not very difficult (21/22) and was made spontaneously (17/22). The amount of information about the risks of LRLT was limited at the time of decision but increased remarkably immediately before the operation. In 28%, family conflicts occurred (5/22). Retrospectively, all but two donors (91%) would donate again. On average, donors started working after 9 (+/-3.7) weeks and felt fully recovered after 13 (+/-7.3) weeks. Adverse financial affects were experienced by 41% of the donors (9/22) because of the donation, and four of those received a compensation. Importantly, quality of life did not differ between donors and nondonors. CONCLUSION: Donors viewed LRLT positively. Quality of life after donation did not change. However, donors had a prolonged period of physical rehabilitation, and 41% experienced financial disadvantages.