Impact of Preoperative Treatment on Donor Hepatic Steatosis in Living Donor Liver Transplantation

BACKGROUND Living donor liver transplantation (LDLT) faces increasing challenges due to the rising prevalence of hepatic steatosis among potential donors. Moderate steatosis (30-60%) is particularly problematic, often leading to donor exclusion and reducing the available donor pool. Preoperative interventions aiming to reduce hepatic fat content have emerged as a potential strategy, but data regarding their safety and efficacy remain limited. MATERIAL AND METHODS This retrospective, single-center study evaluated 34 living liver donors between June 2023 and August 2024. Fourteen donors received preoperative treatment for moderate hepatic steatosis, while 20 donors with mild or no steatosis served as controls. Pre- and post-treatment assessments included body mass index (BMI), liver fat assessment via computed tomography (CT), liver function tests, and perioperative outcomes. RESULTS Preoperative treatment significantly reduced hepatic fat content, with all treated donors achieving steatosis levels below 30% (P<0.001). BMI and GGT levels also decreased significantly after treatment (P=0.01 and P=0.04, respectively). Postoperative liver function, intensive care unit stay, and hospital discharge times were comparable between the treated and control groups (P>0.05). No donor experienced serious complications during the early postoperative period or the first year of follow-up. All donors maintained satisfactory graft and remnant liver function, and no treatment-related adverse events were observed. CONCLUSIONS Preoperative management of moderate hepatic steatosis in living liver donors is effective in reducing liver fat to acceptable levels without compromising donor safety. This approach offers a promising strategy to expand the LDLT donor pool. Further large-scale, multicenter studies with extended follow-up are necessary to validate these findings.