Long-term risk of a fatty liver in liver donors

Aim: Approximately 30 years have passed since the first experience of living donor liver transplantation. The time to evaluate the long -term safety of living donors has been fulfilled. Meanwhile, nonalcoholic fatty liver disease is increasingly common and a critical problem. The aim of this study was to evaluate the safety of living donor, focusing on fatty liver postdonation hepatectomy.Methods: Living donors (n = 212, 1997- 2019) were evaluated by computed tomog- raphy (CT) at > 1 -year postdonation. A liver to spleen (L/S) ratio of < 1.1 was defined as fatty liver.Results: Among 212 living liver donors, 30 (14.2%) detected fatty liver at 5.3 +/- 4.2 years postdonation. The cumulative incidence rates of fatty liver were 3.1%, 12.1%, 22.1%, and 27.7% at 2, 5, 10, and 15 years postdonation, respectively. Of 30 subjects who de- veloped fatty liver, 18 (60%) displayed a severe steatosis (L/S ratio < 0.9). Five (16.7%) had a prior history of excessive alcohol abuse. More than 30% developed metabolic syndrome including obesity, hyperlipidemia, and diabetes. Although six (20%) had a Fib -4 index of > 1.3, which included a case with a Fib -4 index of > 2.67, no significant increased Fib -4 index was observed in the subjects with fatty liver as compared to those without fatty liver (p = 0.66). The independent predictive risk factors for devel- oping fatty liver were male sex, pediatric recipient, and higher body mass index (> 25) at donation.Conclusion: Living donors with risk factors for developing fatty liver should be care- fully followed -up for the prevention and management of metabolic syndrome.