Histopathological findings in gallbladders of asymptomatic living liver donors at a liver transplant center

Abstract

Background & Objective: In low and middle-income countries (LMICs), living donor liver transplant (LDLT) is common due to limited cadaveric grafts. Cholecystectomy during donor hepatectomy allows evaluation of gallbladder pathologies in healthy donors. This study examined the prevalence of gallbladder pathologies in healthy living liver donors.

Methodology: This study included both retrospective and prospective data collection from consecutive liver donors at a single liver transplant center, using a prospectively maintained database. Gallbladders were classified as normal or abnormal based upon histopathology. Chi-square tests were used to determine associations between gallbladder pathologies with age, body mass index (BMI), blood group and Liver Attenuation Index (LAI).

Results: Among 677 donors, 277 (40.92%) were female, with an age range of 18-53 years. None reported biliary symptoms during initial evaluation. Chronic cholecystitis was incidentally found in 68.69% of donors. Of these, 383 cases (82.37%) had chronic cholecystitis only, while 82 (17.63%) showed additional histopathological findings. Specifically, 5 cases (0.7%) had chronic cholecystitis with both cholesterolosis and gallstones, and 6 (0.9%) had it with gallstones only. Chronic cholecystitis showed a significant association with age (p < 0.001) and BMI (p = 0.018), but not with blood group (p = 0.121) or LAI (p = 0.086).

Conclusion: Chronic cholecystitis is highly prevalent among asymptomatic living liver donors and is significantly associated with increasing age and BMI, this may raise concern about the health of the broader Pakistani population. These findings confirm that subclinical gallbladder pathology exists frequently in healthy individuals despite negative preoperative screening.