LAUSR

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.