LOW donor fasting glucose (DFG) levels (<85 mg/dL) are significantly associated with reduced graft survival and increased risk of graft failure following living donor liver transplantation (LDLT), particularly when combined with other risk factors such as older donor age, longer cold ischemic time, and low graft-to-recipient weight ratio (GRWR).
This study aimed to assess the impact of DFG on post-transplantation outcomes in 950 adult LDLT recipients treated at a single centre in Korea between July 2005–December 2022. Eligible patients were divided into two groups: low-DFG (n=120) and control (≥85 mg/dL; n=830). Retrospective analysis was performed to determine whether low DFG levels were associated with poorer graft survival rates. Patient demographics and other donor-specific factors, such as donor age and ischemic time, were analysed to evaluate their combined influence on outcomes.
The 5-year graft survival rate was significantly lower in the low-DFG group (71.5%) compared to the control group (80.0%; P=0.02). Multivariable Cox regression analysis confirmed that low DFG was independently associated with graft loss (hazard ratio: 1.72; 95% CI: 1.15–2.56; P=0.008). Propensity score matching corroborated these findings, with the low-DFG group showing significantly reduced survival rates (71% versus 83.1%; P=0.004). Additional risk factors, including a low graft-to-recipient weight ratio, older donor age, and extended cold ischemic time, further exacerbated graft failure in patients with low DFG levels.
These findings suggest that low DFG levels could serve as an important prognostic marker when planning LDLT. Incorporating DFG measurement into donor evaluation protocols may enhance risk stratification and improve patient outcomes by enabling more tailored perioperative strategies. Further research is required to elucidate the underlying mechanisms linking low DFG to adverse outcomes and to explore potential interventions to mitigate these risks. These insights hold the potential to refine current clinical practices and optimise long-term outcomes for LDLT recipients.
Jenna Lorge, EMJ
Reference
Koh HH et al. Association between low fasting glucose of the living donor and risk of graft loss in the recipient after liver transplantation. Nature. 2025;DOI:10.1038/s41598-024-80604-x.
