Live Donors in Liver Transplantation

Abstract

Living donor liver transplantation (LDLT) has been controversial since its inception. Begun in response to deceased donor organ shortage and waiting list mortality, LDLT was initiated in 1989 in children, grew rapidly after its first general application in adults in the US in 1998, and has declined since 2001. There are significant risks to the living donor, including the risk of death and substantial morbidity, and two highly publicized donor deaths are thought to have contributed to decreased enthusiasm for LDLT. Significant improvements in outcomes have been seen over recent years and data, including from the NIH-funded Adult-to-Adult Living Donor Liver Transplantation Cohort Study, A2ALL, has established a survival benefit from pursuing LDLT. Despite this, LDLT still comprises less than 5% of adult liver transplants, significantly less than in kidney transplantation where living donors comprise approximately 40% of all transplant performed. The ethics, optimal utility and application of LDLT remain to be defined. In addition, most studies to date have focused on post-transplant outcomes and not included the effect of the learning curve on outcome or the potential impact of LDLT on waiting list mortality. Further growth of LDLT will depend on defining the optimal recipient and donor characteristics for this procedure as well as broader acceptance and experience in the public and in transplant centers.

Predictive factors of early graft loss in living donor liver transplantation

“…Living donor liver transplantation is an important option for patients on the transplant waiting list and adequate selection of recipients is fundamental to prevent retransplantation and complications inherent to the procedure, including death of the transplant recipient due to graft failure (7,12) . Although the present study only included patients submitted to living donor transplantation, the results were similar to those reported for other Western series involving living or deceased donors (1,9,10,22,25,33) .…”

“…Liver transplantation is currently the treatment of choice to save the lives of patients with end-stage liver diseases or fulminant hepatic failure (2,7,8) . In 1963, Thomas Starzl performed the first three liver transplantations but without achieving 1-year survival (29) .…”

Living donor liver transplantation using dual grafts: Experience and lessons learned from cases worldwide

“…37 The impact of a donor death on the surviving recipient, the whole family, and the transplant team are immense and far reaching. 38 Dual graft LDLT puts 2 donors at risk for 1 recipient. However, because right lobe donation is associated with higher morbidity and mortality than left lobe donation, some hold the view that dual left lobe LDLT actually represents less in combined donor risk, considering 2 minor left hepatectomies to be less risky than 1 major right hepatectomy.…”

Leberlebendspende – primum nihil nocere?

“…40% aller Organe von lebenden Spendern gestellt werden. 2 Ursächlich hierfür sind nicht ausschliesslich die substantiellen Risiken für den Spender sondern auch die Ausweitung der Kriterien für zulässige Lebertransplantate. So wurden Ende der 90er Jahre auch die Transplantation von Lebern älterer Patienten (über 60 jährig), Leberspenden nach Herzstillstand (non heart beating donors) und Organe mit Steatose sowie Exposition zu Hepatitis B und C zugelassen.…”