Optifast may increase odds of candidacy for live transplant donors

SAN FRANCISCO — Data presented during the Transplant Plenary II session at The Liver Meeting 2015 showed that Optifast lowered hepatic steatosis in potential live liver transplant donors, which could increase their chances of undergoing live donation safely.

“The problem we face though in the context of a worsening obesity epidemic is that there is an increase in prevalence of hepatic steatosis in the general population, which is threatening the candidacy of many otherwise suitable live donors,” Adam Doyle, MD, of the Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada, said during his presentation. “So what we wondered is if an intervention could be applied … to convert them to suitable live liver donors.”

Doyle and colleagues evaluated 447 potential live donors in the University Health Network, Toronto, Ontario, Canada, liver transplant program, of which 34 potential donors presented with high BMI or evidence of steatosis. Of the 34 live donors, 21 began a diet regimen with Optifast (Nestlé Health Science) for at least 4 weeks. According to the presentation, patients put on the Optifast substituted all meals for 4 Optifast 900 shakes and were allowed to drink up to 2 L of water, coffee/tea without milk or sugar per day. No other foods or liquids were allowed, and no exercise regimen was put in place for the patients.

Postsurgical outcomes for donors and recipients were analyzed and compared with 53 who did not receive Optifast and underwent donor hepatectomy within the same study period.

Overall, 16 donors completed their diet regimen with Optifast. The mean BMI of Optifast donors was 35 at baseline with an interquartile range (IQR) of 33.1 to 37.3 and reduced to 31.2 (IQR: 28-33.4) after Optifast. Controls had a mean BMI of 26.4 at baseline and IQR of 25.4 to 27.4 compared with a BMI of 25.9 and IQR of 23.1 to 29.1 after completion of the study.

“There was a universal reduction in steatosis for all who underwent treatment with Optifast,” Doyle said.

A majority of Optifast donors remained candidates for live donor hepatectomy and proceeded to surgery after treatment ended. No donors were excluded due to persistent obesity. No significant differences in post-transplant donor and recipient outcomes between donors treated with and without Optifast were observed, according to the presentation.

Doyle concluded: “This study demonstrates that use of Optifast has the potential to effectively expand the live donor pool in the context of our current obesity and fatty liver epidemic.” – by Melinda Stevens

Reference:

Doyle A, et al. Abstract 11. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: Doyle reports no relevant financial disclosures. Please see the abstract for a full list of all other authors’ relevant financial disclosures.