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Liver, Humans, Fibrosis, Liver Transplantation, Risk Assessment, Algorithms, Living Donors, United States, Non-alcoholic Fatty Liver Disease, Organ Transplantation, Hepatitis, Chronic Liver Disease and Cirrhosis, Transplantation, Digestive Diseases, Liver Disease, Oral and gastrointestinal, Good Health and Well Being, Clinical Sciences, and Surgery

To reduce waitlist mortality, living donor liver transplantation (LDLT) has increased over the past decade in the United States, but not at a rate sufficient to completely mitigate organ shortage. As a result, there are ongoing efforts to expand the living liver donor pool. Simultaneously, the prevalence of nonalcoholic fatty liver disease (NAFLD) in the general population has increased, which has significant implications on the pool of potential living liver donors. As such, a clinical assessment algorithm that exhaustively evaluates for NAFLD and fibrosis is critical to the safe expansion of LDLT. An ideal algorithm would employ safe and noninvasive methods, relying on liver biopsy only when necessary. While exclusion of NAFLD and fibrosis by noninvasive means is widely studied within the general population, there are no well-accepted guidelines for evaluation of living donors using these modalities. Here we review the current literature regarding noninvasive NALFD and fibrosis evaluation and propose a potential algorithm to apply these modalities for the selection of living liver donors.

Humans, Kidney Transplantation, Registries, Retrospective Studies, Comorbidity, Graft Survival, Adolescent, Adult, Aged, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Living Donors, Tissue and Organ Procurement, Waiting Lists, United States, Female, Male, Renal Insufficiency, Young Adult, Pandemics, Transplant Recipients, COVID-19, SARS-CoV-2, clinical research/practice, donors and donation: deceased, donors and donation: living, health services and outcomes research, infection and infectious agents - viral, infectious disease, kidney transplantation/nephrology, organ transplantation in general, patient survival, registry/registry analysis, clinical research, practice, donors and donation, deceased, living, kidney transplantation, nephrology, registry, registry analysis, Preschool, Newborn, Surgery, and Medical and Health Sciences

In March 2020, coronavirus disease 2019 (COVID-19) spread rapidly nationally, causing widespread emergent changes to the health system. Our goal was to understand the impact of the epidemic on kidney transplantation (KT), at both the national and center levels, accounting statistically for waitlist composition. Using Scientific Registry of Transplant Recipients data, we compared data on observed waitlist registrations, waitlist mortality, and living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from preepidemic data January 2016-February 2020. There were few changes before March 15, at which point the number of new listings/DDKT/LDKT dropped to 18%/24%/87% below the expected value (all P