The Incidence and Management of Nonalcoholic Fatty Liver Disease in Potential Kidney Donors.

Abstract

Purpose: To determine the incidence and management of NAFLD and NASH in prescreened living kidney donors. Methods: Between January 2010 and December 2013, 399 potential kidney donors were registered and underwent blood and HLA typing at our institution. Of these potential donors, 106 completed the evaluation including computed tomography (CT) scan. Diagnosis of NAFLD was based upon presence of hepatic steatosis on imaging using liver to spleen ratio (L:S ratio, <1.1) criteria, and absence of anti-HCV and HBsAg, and negative history of excessive alcohol use, and secondary causes of hepatic steatosis or other causes of elevated serum ALT or AST (LFTs). 14 patients (13.2%) had elevated ALT, TB or AST, and 10 patients (9.4%%) had hepatic steatosis noted on CT. 6 patients (5.6%) had both abnormal LFTS and hepatic steatosis on imaging. Results: From the group with abnormal LFTs or imaging, 8 patients (44%) proceeded to donation. Patients with mild steatosis and normal BMI and LFTs were allowed to donate (2). 2 patients had normalization of LFTs without intervention. 3 patients with mild transaminase elevation and/or mild steatosis on imaging were counseled about diet and weight loss, and allowed to donate once transaminases normalized. Average weight loss was 8 lbs. A patient with persistent abnormal LFTs, but normal BMI and imaging was referred for a liver biopsy examination. Liver biopsy showed mild (5-10%) steatosis without signs of NASH and he was cleared for donation. 10 patients were not cleared for donation. 4 patients were ruled out for medical or anatomic issues without work up of for liver disease. One patient was referred to hepatology and but had improvement in LFTs after weight loss, however was ruled out due to the presence of nephrolithiasis. 5 patients were excluded based upon on the presence of significant liver disease. One patient was found to have alcohol abuse as likely contributing factor for liver disease. 2 patients did not proceed with their evaluation after being referred to hepatology for further work up and liver biopsy. 2 patients had NASH without cirrhosis on liver biopsy and were excluded from donation. Conclusion: 10 - 13% of healthy potential living kidney donors are found to have NAFLD based upon either elevated ALT/AST or imaging during work up. Patients with mild transaminase elevation or mild steatosis on imaging are likely ok to proceed with donation, especially if diet and weight loss leads to normalization of ALT and AST. Patients with significant steatosis on imaging or persistent elevation