Treatment with Optifast reduces hepatic steatosis and increases candidacy rates for living donor liver transplantation

Over the last 3 decades, rates of obesity have risen dramatically worldwide.As such, the pool of potential living donors for liver transplantation is now frequently populated by patients with fatty liver disease (steatosis).Graft steatosis in liver transplantation is associated with poor recipient outcomes, including biliary strictures, primary graft nonfunction, and decreased 1-year graft survival.(1) Strategies to deplete or reduce fatty livers in potential donors are necessary to optimally use available living donors.Optifast is a very low calorie diet (VLCD) meal replacement product reported to cause rapid weight loss and reduction in hepatic steatosis in the bariatric surgery literature.(2) We began the use of Optifast in January 2012 as a treatment strategy for potential donors with radiological or histopathological evidence of hepatic steatosis.We provide a retrospective review of the efficacy and safety of this agent in converting steatotic donors into suitable candidates for living donor liver transplantation. Methods PATIENT SELECTIONWe performed a retrospective cohort review of all potential liver donors evaluated in our center between September 1, 2011 and December 31, 2014.Followup occurred until September 1, 2015.This study was approved by the research ethics board of the University Health Network, Toronto, and adhered to the ethical guidelines of the 1975 Declaration of Helsinki.Our study population included all living donor candidates with hepatic steatosis (>10%) at baseline, who were treated with Optifast and received follow-up liver biopsies during their evaluation.Living donor candidates were evaluated using previously published protocols.(3) Patients with suspected nonalcoholic steatohepatitis (NASH), based on deranged liver enzymes without an alternate cause, were not considered for Optifast treatment.Hepatic steatosis was determined based on either imaging, liver biopsy, or both.Steatosis was quantified on computed tomography using the Kodama equation for unenhanced liver attenuation.(4) Steatosis was quantified on magnetic resonance imaging (MRI) using chemical shift imaging based on dual echo in-phase and opposed-phased T 1 -weighted gradient imaging.