Current trends in live liver donation (original) (raw)
Related papers
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2018
By cause of the shortfall between the number of patients listed for liver transplantation (LT) and available grafts, strategies to expand the donor pool have been developed. Donation after Circulatory Death (DCD) and Living donor (LD) grafts are not universally used due to the concerns of graft failure, biliary complications and donor risks. In order to overcome the barriers for the implementation of using all three types of grafts, we compared outcomes after LT of DCD, LD and donation after brain death (DBD) grafts. Patients who received a LD, DCD or DBD liver graft at the University of Toronto were included. Between January 2009 through to April 2017, 1054 patients received a LT at our center. Of these, 77 patients received a DCD graft (DCD-group), 271 a LD graft (LD-group) and 706 a DBD graft (DBD-group). Overall biliary complications were higher in the LD-group (11.8%) compared to the DCD-group (5.2%) and to the DBD-group (4.8%), p<0.001. The 1-, 3- and 5-year graft survival ...
Living Donor Liver Transplantation
ANZ Journal of Surgery, 2011
r Living donor liver transplantation has been a major area of development in the field for the last two decades. r Major technical and physiological advances have made this technology the standard of care in parts of the world where the deceased donor options are rare or non-existent. r In most Western countries where the majority of liver transplantation is performed with deceased donor grafts, the decision to use a living donor rather than wait for a deceased donor graft is a complicated ethical and surgical conundrum. r The combination of concern for donor safety and the possible availability of a deceased donor graft has limited the expansion of adult-to-adult living donor liver transplantation in the West.
Donor outcome in live-related liver transplantation
Medical Journal Armed Forces India, 2014
Background: Live donor liver transplant has become an accepted, effective and lifesaving alternative to deceased donor transplant. The effect on donor and his safety remains a cause of concern. The donors are all in productive age and in our setting may have to go back to active service. This study is aimed at knowing the results of donor hepatectomies at our centre. Methods: Data of all donor hepatectomies done at our centre from Apr 2007 to Jun 2013 reviewed. This included the preoperative workup, operative details and postoperative follow-up. Results: 35 Donors of age between 20 and 50 years were taken up for procedure of which one was abandoned due to haemodynamic instability after intubation. In the 34 procedures done the percentage of the residual liver was at least 30%. No donor required blood transfusion. The overall complication rate was 26.5% which was stratified according to the modified Clavien classification of postoperative complications. There was transient rise of bilirubin and liver enzymes in all which returned back to normal with time. Infections were the most common cause of complication. All the donors had gone back to their work after a mean of 42 days after surgery. All donors were willing to donate again if needed. Conclusion: Living donor liver transplant a widely practiced modality for end-stage liver disease. It is a safe procedure with good recovery and results. Our study shows that meticulous selection criteria and strict adherence to protocols leads to good outcome.
Liver Transplants from Living Donors
Apollo Medicine, 2006
In the west majority liver transplantation is from deceased donors. In the Far East most liver transplant is actually done from living related donors. In the past, when experience with hepatectomy was limited, liver transplantation did not progress because of lack of cadaveric donors. With hepatectomy becoming a safe operation, liver transplant from living donors is a good alternative. Although there is a risk to donor, LRLT has certain advantages over DDLT in our country such as optimum patient preparation prior to surgery, allows use of cadaveric organs when available, for patients with primary liver turnover, for adoptive transfer of immunity in patients with hepatitis B related cirrhosis and in acute liver failure. LRLT should be promoted and safeguards built in for donor safety.
Evaluation of 100 patients for living donor liver transplantation
Liver Transplantation, 2003
The initial success of living donor liver transplantation (LDLT) in the United States has resulted in a growing interest in this procedure. The impact of LDLT on liver transplantation will depend in part on the proportion of patients considered medically suitable for LDLT and the identification of suitable donors. We report the outcome of our evaluation of the first 100 potential transplant recipients for LDLT at the University of Colorado Health Sciences Center (Denver, CO). All patients considered for LDLT had first been approved for conventional liver transplantation by the Liver Transplant Selection Committee and met the listing criteria of United Network for Organ Sharing status 1, 2A, or 2B. Once listed, those patients deemed suitable for LDLT were given the option to consider LDLT and approach potential donors. Donors were evaluated with a preliminary screening questionnaire, followed by formal evaluation. Of the 100 potential transplant recipients evaluated, 51 were initially rejected based on recipient characteristics that included imminent cadaveric transplantation (8 patients), refusal of evaluation (4 patients), lack of financial approval (6 patients), and medical, psychosocial, or surgical problems (33 patients). Of the remaining 49 patients, considered ideal candidates for LDLT, 24 patients were unable to identify a suitable donor for evaluation. Twenty-six donors were evaluated for the remaining 25 potential transplant recipients. Eleven donors were rejected: 9 donors for medical reasons and 2 donors who refused donation after being medically approved. The remaining 15 donorrecipient pairs underwent LDLT. Using our criteria for the selection of recipients and donors for LDLT gave the following results: (1) 51 of 100 potential transplant recipients (51%) were rejected for recipient issues, (2) only 15 of the remaining 49 potential transplant recipients (30%) were able to identify an acceptable donor, and (3) 15 of 100 potential living donor transplant recipients (15%) were able to identify a suitable donor and undergo LDLT. Recipient characteristics and donor availability may limit the widespread use of LDLT. However, careful application of LDLT to patients at greatest risk for dying on the waiting list may significantly reduce waiting list mortality.
Living-donor liver transplantation: evaluation of donor and recipient
Nephrology Dialysis Transplantation, 2004
Living-donor liver transplantation (LDLT) in adults has been expanded after becoming the standard for children in many transplant centres. Advantages of LDLT include thorough donor screening, optimization of timing for transplantation and minimal cold ischaemia time. However, the risk of donor morbidity and mortality must be considered. The preoperative evaluation of the donor typically is performed in consecutive stages. Specific donor considerations in LDLT are thrombosis and embolism, hepatic mass and hepatic steatosis. After complete evaluation, only a small proportion of potential donors are satisfactory candidates. The evaluation protocol for LDLT recipients in most centres is not different from that of cadaveric transplantation. More experience and the development of specific selection and evaluation criteria will further increase the benefit for the recipient and decrease the risk of the donor.
American Journal of Transplantation, 2007
is not yet a fully accepted therapy for patients with end-stage liver failure in the Western hemisphere because of concerns about donor safety and inferior recipient outcomes. An outcome analysis from the time of listing for all adult patients who were listed for liver transplantation (LT) at our center was performed. From 2000 to 2006, 1091 patients were listed for LT. One hundred fifty-four patients (LRD; 14%) had suitable live donors and 153 (99%) underwent RLDLT. Of the remaining patients (DD/Waiting List; n = 937), 350 underwent deceased donor liver transplant (DDLT); 312 died or dropped off the waiting list; and 275 were still waiting at the time of this analysis. The LRD group had shorter mean waiting times (6.0 months vs. 9.8 months; p < 0.001). Although medical model for endstage liver disease (MELD) scores were similar at the time of listing, MELD scores at LT were significantly higher in the DD/Waiting List group (15.4 vs. 19.5; p = 0.002). Patients in Group 1 had a survival advantage with RLDLT from the time of listing (1-year survival 90% vs. 80%; p < 0.001). To our knowledge, this is the first report to document a survival advantage at time of listing for RLDLT over DDLT.
Improvement in Survival Associated With Adult-to-Adult Living Donor Liver Transplantation
Gastroenterology, 2007
Background and Aims-More than 2000 adult-to-adult living donor liver transplants (LDLT) have been performed in the U.S., yet the potential benefit to liver transplant candidates of undergoing LDLT compared to waiting for deceased donor liver transplant (DDLT) is unknown. The aim of this study was to determine if there is a survival benefit of adult LDLT Methods-Adults with chronic liver disease who had a potential living donor evaluated from 1/98 to 2/03 at nine university-based hospitals were analyzed. Starting at the time of a potential donor's evaluation, we compared mortality after LDLT to mortality among those who remained on the waitlist or received DDLT. Median follow-up was 4.4 years. Comparisons were made by hazard ratios (HR) adjusted for LDLT candidate characteristics at the time of donor evaluation.