Research conducted at Severance Hospital, Korea, has revealed concerning insights about donor health and transplant outcomes, finding a significant connection between low fasting glucose levels in living liver donors and the risk of graft loss for recipients after liver transplantation.
The study analyzed data from 950 patients who underwent living donor liver transplantation (LDLT) from July 2005 to December 2022. It focused on donor fasting glucose (DFG) levels, categorizing subjects as low-DFG if their levels were below 85 mg/dL and control if they were 85 mg/dL or higher. The results indicated stark differences between the two groups, emphasizing the need to evaluate this aspect of donor health during the transplant selection process.
The findings present major clinical significance; the five-year graft survival rate for the low-DFG group was marked at 71.5%, contrasting with 80.0% for the control group—a statistically significant difference with clear clinical ramifications (P = 0.02). Multivariable analysis, using Cox regression models, reinforced these findings, highlighting low DFG as an independent risk factor for graft loss with a hazard ratio of 1.72.
The rationale behind linking low donor fasting glucose to graft failure hinges on the liver's role as the primary organ for glucose regulation. It offers insight, as previous research showed individuals with compromised liver function exhibit significantly impaired glucose metabolism. This has real-world consequences, as low blood glucose levels correlate with poor outcomes and increased risks of postoperative complications.
Low DFG is particularly concerning when it coincides with other risk factors, such as lower graft-to-recipient weight ratio (GRWR), older donor age, and prolonged cold ischemic time during the transplantation process. The study found graft survival rates lower across all timeframes when these factors co-existed, presenting serious challenges for patient management strategies.
Despite being deemed healthy at the time of donation, low fasting glucose levels may indicate underlying functional impairments within the donor's liver—factors not immediately evident through traditional screening methods. This research proposes considering DFG levels as part of routine evaluation and donor selection criteria.
This study's findings stress the need for enhancing protocols surrounding donor assessment. While both clinical and ethical aspects of donor health are thoroughly vetted, incorporating preoperative glucose assessments could lead to more informed decision-making processes, potentially reducing rates of graft failure and increasing overall patient survival rates.
Understanding the interplay between donor health and transplant outcomes marks a significant step forward for medical practices associated with living donor liver transplantation. Further investigations are needed to elucidate the detailed mechanisms at play and whether similar trends are observed across larger, multi-centre studies.
Concluding, the study posits low DFG as needing recognition as both prognostic and practical markers when planning LDLT procedures, aiming to refine patient outcomes through responsible screening and proactive management strategies.