The International Liver Transplantation Society Living Donor Liver Transplant Recipient Guideline

Abstract

Living donor liver transplantation (LDLT) has been increasingly embraced around the world as an important strategy to address the shortage of deceased donor livers. The aim of this guideline, approved by the International Liver Transplantation Society (ILTS), is to provide a collection of expert opinions, consensus, and best practices surrounding LDLT. Recommendations were developed from an analysis of the National Library of Medicine living donor transplantation indexed literature using the Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care of living donor liver transplant recipients.

Life‐threatening or nearly life‐threatening complications in living liver donors

“…A clear consensus has not yet been established as to the relationship between transplant centers’, surgeons’ experience, and complications. According to a guideline published by Miller et al for ILTS in 2017, centers reach a steady state after they perform 15‐20 LDLT procedures, with the learning curve having an impact on patient outcomes (Class I, Level B). However, Cheah et al advocated that the number of learning threshold should be increased from its current recommended level of 20 cases to minimize complications.…”

Preformed donor‐specific antibodies do not affect the 1‐year allograft survival in living donor liver transplantation

“…The preformed DSA may act in a different manner in the deceased graft setting, where the graft ischemic damage is more significant. Second, most grafts were not small‐for‐size grafts (graft‐to‐recipient body weight ratio ≥0.8 in 96.7%) . Third, hepatitis B virus‐related liver cirrhosis was dominant at baseline (72.1%), which offers a better survival outcome as compared with hepatitis C virus‐related liver disease.…”

“…Levintsky et al31 reported that DSAs may have a higher effect on deceased donor LT than on LDLT recipient, although the procedures are similar in prevalence. Perera et al32 reported that there is no association between anti-HLA DSA and preservation-reperfusion injury, but preformed DSA may cause early morbidity in deceased donor LT.The preformed DSA may act in a different manner in the deceased graft setting, where the graft ischemic damage is more significant.Second, most grafts were not small-for-size grafts (graft-to-recipient body weight ratio ≥0.8 in 96.7%) 33. Third, hepatitis B virus-related liver cirrhosis was dominant at baseline (72.1%), which offers a better survival outcome as compared with hepatitis C virus-related liver disease.It is currently accepted that tissue deposition of C4d, the final split product resulting from the proteolytic cleavage of complement element C4, is a marker of humoral alloreactivity 34,35.…”

Laparoscopic left lateral section procurement in living liver donors: A single center propensity score‐matched study

“…Donor selection was accomplished according to national and international guidelines, comprising three main steps. The first step included evaluating the patient's general health and obtaining informed consent.…”