General-motors diet: A quick fix for steatotic live liver donors

Abstract

Background and aims

GM (General-Motors) diet is a low-calorie 7-day diet plan using complex carbohydrates used for quick weight loss. Dietary optimisation is known to decrease steatosis and improve outcomes in liver donors. We evaluated the efficacy and feasibility of using GM diet in steatotic live liver donors (LLD).

Methods

LLDs who either had BMI > 30 kg/m², Computerised tomography liver attenuation index (CT-LAI) < 0 HU, Magnetic resonance (MR) fat-fraction of >10% were started on GM diet for 1 week. Records of these LLDs and their recipients were retrieved retrospectively and analysed. Weight, liver function tests(LFT), MR fat-fraction, CT-LAI, hospital-stay and complications were analysed in LLDs while early graft dysfunction (EGD) and complications were assessed in recipients.

Results

A total of 51 LLDs with mean age of 34.6±9.5 years with baseline mean weight of 80.6±10.8 kg and BMI of 29.1±2.78 kg/m² were started on GM diet. After a week of following the GM diet, there was an average weight loss of 3.46±2.1 kg, a decrease in fat-fraction by 3.8%±2.7, and an improvement in CT-LAI by 6.7±3.7 HU. All patients could successfully undergo donor hepatectomy with an average postoperative ICU stay of 2.86±0.8 days and hospital stay of 6.82±0.81 days. No donor had steatosis > 10% on intraoperative Tru-cut biopsy and their post-operative outcomes were similar to normal liver donors. There were intra-abdominal collections in 2 donors requiring drainage and one required re-exploration for intestinal obstruction. There was EGD in 8 recipients (15.6%) and mortality in 1(1.9%) recipients.

Conclusion

GM diet is safe and effective regimen to reduce steatosis and increase healthy LLD pool without compromising donor or recipient safety.