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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.
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LDLT currently accounts for 5% of liver transplants performed worldwide.
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ADVANTAGES OF LDLT OVER DDLT
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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
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DISADVANTAGES OF LDLT OVER DDLT
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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.
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Ensure donor suitability and confidentiality.
Start donor evaluation early.
Donor safety is the gold standard even when the recipient is very ill.
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INFORMING THE DONOR AND DONOR ADVOCACY
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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.
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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 ...