title: Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation.
abstract: BACKGROUND
  The use of steatotic livers is associated with increased primary nonfunction in liver transplantation. To reduce the risk of liver injury, we applied a short-term combination therapy of diet, exercise and drugs for 11 living-donor liver transplantation (LDLT) candidates with steatosis.
  
  
  METHODS
  Subjects were treated with a protein-rich (1000 kcal/day) diet, exercise (600 kcal/day), and bezafibrate (400 mg/day) for 2-8 weeks.
  
  
  RESULTS
  The treatment significantly improved macrovesicular steatosis (30+/-4% vs. 12+/-2% [mean +/- SEM], P = 0.0028). Body weight and BMI were significantly reduced (73.7 +/- 3.2 kg vs. 66.9 +/- 2.9 kg, P = 0.0033, 26.4 +/- 0.7 kg/m vs. 24.1 +/- 0.8 kg/m, P = 0.0033). The treatment completely normalized liver function tests and lipid metabolism. Seven treated liver grafts (left lobe) were transplanted to the recipients. We compared transplanted graft function and resected liver function of donors using parameters such as peak total bilirubin, prothrombin time at postoperative day 3, and peak alanine aminotransferase between treated liver (n = 7) and donor liver without hepatic steotosis (n = 37). The transplanted grafts showed good liver functions, and there was no difference between them with respect to functional parameters. The treated donors also showed good liver functions, and no significant differences in functional parameters.
  
  
  CONCLUSIONS
  The results of this study indicate that our short-term treatment effectively reduced steatosis and contributed to safer LDLT. Our findings also suggest that even severely steatotic livers can be used for LDLT grafting subsequent to our short-term treatment regimen.
authors.affiliation: Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakamuta
authors.forename: Shusuke
authors.initials: S
authors.lastname: Morizono
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tomoharau
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Shinji
authors.initials: S
authors.lastname: Aishima
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Takasugi
authors.forename: Kengo
authors.initials: K
authors.lastname: Yoshimitsu
authors.forename: Munechika
authors.initials: M
authors.lastname: Enjoji
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kotoh
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Hajime
authors.initials: H
authors.lastname: Nawata
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D001629:Bezafibrate / Q000008:administration & dosage*; D001706:Biopsy; D004044:Dietary Proteins / Q000008:administration & dosage; D015444:Exercise; D005234:Fatty Liver / Q000178:diet therapy / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement
chemical_list: D004044:Dietary Proteins; D000960:Hypolipidemic Agents; D001629:Bezafibrate