Impact of donor obesity on paediatric liver transplantation; current evidence and potentials for graft pool expansion

Table 1 Strategies to optimize donor grafts

Optimization Strategy	Description	Potential benefit
Preoperative weight loss programs	Encourages weight reduction in living donors to minimize hepatic steatosis risk	Reduces liver fat content, improving graft function
Normothermic regional perfusion	Maintains oxygenation and perfusion in the liver post-retrieval to reduce ischemia-reperfusion injury	Enhances graft quality, reducing early graft dysfunction risk
Ex vivo liver perfusion	Utilizes machine perfusion to optimize steatotic grafts and improve viability	Increases chances of using grafts from obese donors safely
Steatosis screening via CAP & MRI-PDFF	Advanced imaging techniques used to assess liver fat content and determine graft suitability	Provides more accurate donor liver assessment, reducing rejection risk

CAP: Controlled attenuation parameter; MRI-PDFF: Magnetic resonance imaging-proton density fat fraction.