Background: The application of liver biopsy as one of the selection criteria in living donor liver transplantation (LDLT) is controversial. In populations with high prevalence of liver disease and obesity, it seems logical to include liver biopsy as one of the donor selection criteria. The aim is to maximize the benefit to the recipient and minimize risk to the donor.

Aim: The aim is evaluate the rule of liver biopsy as rejection criteria for LDLT and to ascertain the safety of the procedure to the donor

Methods: From March 2002 to May 2012, a total of 233 deceased donor liver transplants and 188 LDLT were performed at our institution. The number of potential donor worked up was 736. Potential living donors were worked up according to a step-wise evaluation protocol. Those with BMI>28 were excluded. The age of the worked up donors ranged from 18 to 50 years(mean=28).

Results: a total of 548(74%) donors were rejected. Most were rejected at the initial stages of evaluation. In 82 donors(11%) the rejection was for complicated biliary anatomy. Other anatomical reason includes insufficient liver volume in 132(18%) and complicated vessel anatomy in 15(2%). Liver biopsy excluded 94 donors(13%). Significant macrovesicular steatosis (fat more than 10%) was detected in 56 donors (60%) and was the main reason for rejection. Other causes include significant fibrotic changes in 15(16%), significant portal lymphocytic infiltrate in 13(14%), active hepatitis 3(3%), shistosomiasis in 3(3%) and other rare disorders in another 4(4%). There was no major complication from the procedure.

Conclusion: In our experience liver histology excluded 13% of the potential living donors. This percentage is significant and in our opinion justifies the procedure when complication rate is negligible. We therefore recommend liver biopsy as part of the LDLT workup especially in the setting of high prevalence of liver disease.

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