Mild Fatty Liver and History of Elevated Liver Enzymes in Prospective Kidney Donors
A history of moderately elevated liver enzymes that have normalized and mild fatty infiltration of the liver with subsequent weight loss represents a minimal risk for prospective kidney donors and should not be considered a contraindication to donation. 1
Risk Assessment for Kidney Donors with Liver Abnormalities
- Kidney donor evaluation requires assessment of all potential relative contraindications, with no absolute cut-off for mild liver abnormalities that have resolved 1
- The KDOQI commentary on living kidney donor evaluation emphasizes that borderline risk estimates may be tolerable for certain donor candidates, especially in directed donations to close relatives 1
- Transient elevation of liver enzymes is common, with more than 30% of cases normalizing spontaneously during follow-up 2
Clinical Significance of Resolved Fatty Liver Disease
- Non-alcoholic fatty liver disease (NAFLD) with only mild steatosis without fibrosis or inflammation has an excellent prognosis 3
- Weight loss is an effective intervention for improving NAFLD, with studies showing regression of fatty infiltration and normalization of liver enzymes 1
- The absence of periportal fibrosis has a negative predictive value of 100% for predicting liver-related complications in long-term follow-up studies 3
Factors Supporting Low Risk in This Case
- Normalization of liver enzymes indicates resolution of the active inflammatory process 4, 2
- Weight loss after diagnosis of mild fatty infiltration demonstrates appropriate self-management and reduces risk 1
- The description of "very moderately elevated" previous liver enzymes suggests minimal hepatocellular injury that has since resolved 2
Risk Stratification for Transplant Candidates
- While guidelines exist for liver transplant candidates with NAFLD, these focus on severe cases with advanced fibrosis or cirrhosis, not mild cases with normalized enzymes 1
- For transplant candidates, significant liver disease concerns center on decompensated cirrhosis, portal hypertension, and advanced fibrosis - none of which apply to this case 1
- Cardiovascular risk assessment is more critical for transplant candidates than mild, resolved fatty liver 1
Monitoring Recommendations
- Annual dietary assessment is recommended for transplant candidates with any history of fatty liver 1
- Continued weight maintenance or gradual weight loss should be encouraged to prevent recurrence of fatty liver 1
- Regular monitoring of liver enzymes can be performed as part of routine follow-up but is not required at increased frequency given normalized values 2
Important Caveats
- If the donor has other metabolic risk factors (diabetes, hypertension, dyslipidemia), these should be assessed independently as potential risk factors for donation 5, 6
- Ensure that other causes of liver enzyme elevation have been excluded through appropriate testing 4
- While mild fatty liver that has improved with weight loss is low risk, severe obesity (BMI >40) would require separate consideration 1