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INTRODUCTION

Transplantation from a living donor (LDLT) is a modern treatment option for patients with end-stage liver disease even though deceased donor liver transplantation (DDLT) remains the standard of care. Nowadays, there is a 3-fold number of patients on waiting lists than those who have been transplanted. As a result, this need for more grafts has led to the search for other options than DDLT. LDLT was first performed in children in 1989, using a left lateral lobe; transplant from an adult to an adult using the right lobe was first introduced in 1998 in Asia.

LDLT currently accounts for 5% of liver transplants performed worldwide.

ADVANTAGES OF LDLT OVER DDLT

  • The ability to carry out the procedure before the recipient reaches the point of no return

  • The detailed knowledge of donor medical history

  • Reduced cold ischemic time

DISADVANTAGES OF LDLT OVER DDLT

  • The risk presented to the healthy person

  • The technical complexity of receiving a partial graft

GENERAL PRINCIPLES

  • The UK standard for transplant benefit, an overall graft and patient survival of more than 50% at 5 years, is the recommended standard for both DDLT and LDLT. The same selection contraindications apply for both methods.

  • LDLT must only be performed in specialized centers working with a multidisciplinary transplant team.

DONOR EVALUATION

  • Ensure donor suitability and confidentiality.

  • Start donor evaluation early.

  • Donor safety is the gold standard even when the recipient is very ill.

INFORMING THE DONOR AND DONOR ADVOCACY

  • Potential donors should be informed of the complication rates for the specific transplantation center.

  • It has to be clear that it may not be suitable to donate and/or the donor can withdraw from the process at any time.

  • Any kind of support for the donor and their family should be available.

  • All potential donors must undergo an assessment by a mental health team in order to identify mental disorders or inappropriate motivations.

  • A mental health professional has to be able to adequately identify the donor’s consent. This is a 2-stage procedure.

PERFORMANCE STATUS

  • There is no ideal age, but the medical data and preparation of older donors must be extremely detailed, as they have an increased risk of perioperative and postoperative complications.

  • Any donor with a body mass index (BMI) greater than 30 kg/m2 needs a liver biopsy because of the increased risk of hepatic steatosis in the donor and the possibility of steatohepatitis. They also have a high risk during the hepatectomy.

  • There is no contraindication for well-controlled hypertension or for both type 1 and type 2 diabetes.

  • All donors should be checked for cardiovascular disease as a routine matter, and those with reduced exercise capacity or greater than ...

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