Lifestyle Optimization Leads to Superior Liver Regeneration in Live Liver Donors and Decreases Early Allograft Dysfunction in Recipients: A Randomized Control Trial.

INTRODUCTION: The aim of the current RCT was to assess efficacy of donor lifestyle optimisation on liver regeneration and outcome following live donor liver transplantation(LDLT).

METHODS: Live liver donors(LLDs) who were fit with no or minimal steatosis were randomized to receive either a customized low calorie diet with calorie intake equalling their basal requirement along with exercise for 2 weeks prior to surgery versus to continue their normal routine lifestyle. Primary objectives were difference in day of normalization of serum bilirubin and PT-INR and percentage growth of liver at post-operative day 7 and 14. Secondary objectives were differences in intra-operative liver biopsy, liver-regeneration markers, blood loss, hospital stay, complication rate in LLDs and rates of early graft dysfunction(EGD) in recipients.

RESULTS: 62 consecutive LLDs were randomized(28 in intervention vs. 34 in control). Baseline parameters and graft parameters were similar in both groups. LLDs in intervention arm had significantly decreased calorie intake(P<0.005), abdominal girth(P<0.005), BMI(P=0.05) and weight(P<0.0005). The mean blood loss(P=0.038), day of normalisation of bilirubin(P=0.005) and INR(P=0.061), post-operative peak AST(P=0.003), ALT(P=0.025) and steatosis(P<0.005) were significantly less in intervention group. There was significantly higher volume regeneration(P=0.03) in donors in intervention arm. The levels of TNF-α, IL-6 and IL-10 levels were significantly higher while TGF-β level was lower in donors in intervention group. The rate of EGD was significantly higher in recipients in control group(P=0.043).

CONCLUSION: Lifestyle optimisation of LLD is simple to comply, improves liver regeneration in LLDs and decreases EGD in recipients thus can enhance donor safety and outcomes in LDLT.