Fatty liver disease causing problems for organ transplants

MONCTON – Fatty liver disease is on the rise in the Atlantic provinces and it’s causing more people to need liver transplants.

But the same disease is also affecting the pool of available organs, making donor livers not viable for operations.

Fatty liver disease is a build-up of fat in the liver, usually found in people who are obese, diabetic or have metabolic syndrome, according to Dr. Ian Alwayn, the surgical lead of the multi-organ transplant program at Dalhousie Medical School in Halifax, and the QEII chair in transplantation research.

“The Atlantic provinces, unfortunately, have a very high rate of obesity,” Dr. Alwayn said.

“Now fatty liver disease, in and of itself doesn’t really cause many problems, but it can progress. It can turn into steatohepatitis or inflammation, and that can further worsen to fibrosis, cirrhosis and liver failure.”

Dr. Alwayn said researchers are projecting fatty liver disease will soon surpass both liver disease caused by alcohol-use and hepatitis C as the main reason for a liver transplant.

Valdo Grandmaison has been waiting for a liver transplant since last fall. Grandmaison, who lives in Shediac Cape, about 30 km east of Moncton, has fatty liver disease.

His liver only functions at about 20 per cent, and Grandmaison told Global News without a liver transplant he may not be around in six months or a year.

“It’s a daily combat just to keep your sanity and to stay positive,” he said. “I was hoping last fall that they would tell me that my condition could be stabilized, but it’s not the case. My only option is to get a liver transplant. The sooner, the better.”

Grandmaison said he almost died last November, but in the last two months his condition has stabilized and he now has more energy. In that time he has also lost 60 pounds, but every morning he still takes several drugs to counteract the lost function of his liver.

“I’m lucky to be alive today. I’m lucky to be a good candidate for transplant,” he said.

But Grandmaison has ‘O’-negative blood and that means he can only accept a liver from another person with that blood type. That makes it harder for him to find a match.

He has a duffle-bag packed and ready for the hospital in case there is a match and Grandmaison stays within a four-hour drive of Halifax, where he will undergo the surgery.

But Dr. Alwayn says fatty liver disease is also affecting donor livers, making some of them not viable for transplant.

“Like the general population, our organ donors are also becoming more obese and their livers are also becoming fatty,” he said. “So the quality of the organs that we have to transplant is sub-optimal.”

But he and a team of other researchers are hoping to be able to remove the fat from these livers so they can use them in transplantation.

Dr. Alwayn said there is a six to 12 hour window when doctors could potentially manipulate donor livers to improve their quality.

“Instead of storing them on ice as we’re doing now, we could perhaps put them on a pump and perfuse them with a solution that contains agents that may reduce the amount of fat in the liver,” he said.

The research is still in the experimental stage with tests on rat livers, but they are trying to find a solution that would break down the fat so that either the liver could process it or it would be released into the solution.

“Initially we have been just trying to get conditions where we can maintain the viability of the liver,” Neale Ridge said, a professor in biochemistry and pediatrics at Dalhousie Medical School and one of the researchers involved. “We are starting to develop or identify agents we can add to the perfuse aid that will help in our goal to remove triglyceride from the liver.”

Dr. Alwayn said if the research is successful, it could potentially double the number of livers available for transplants.