Living donor liver transplantation
- Scott J Cotler, MD
Scott J Cotler, MD
- Professor of Medicine
- Director, Division of Hepatology
- Loyola University Medical Center
- Section Editor
- Robert S Brown, Jr, MD, MPH
Robert S Brown, Jr, MD, MPH
- Section Editor — Liver Transplantation
- Vice Chair, Transitions of Care, Department of Medicine
- Interim Chief, Division of Gastroenterology and Hepatology
- Weill Cornell Medical College
- Professor of Clinical Medicine, Columbia University College of Physicians & Surgeons
The scarcity of donor organs is the limiting factor in liver transplantation. While over 6000 transplants are performed annually in the United States, more than 2000 candidates die each year on the liver transplant waiting list. Living donor liver transplantation (LDLT) provides one means to expand organ availability. Living-donation of the lateral segment of the left lobe of the liver has become highly successful in pediatric transplantation. Some transplant centers perform adult-to-adult right lobe and, less commonly, left lobe LDLT.
Advantages of LDLT include thorough donor screening, optimization of timing for transplantation, and minimal cold ischemia time . LDLT has also been associated with lower recipient mortality compared with waiting for a deceased donor . A decision analysis concluded that the addition of LDLT to a standard waiting list for deceased donor liver transplantation was effective at improving recipient survival and preventing waiting list deaths, but at greater cost . By contrast, a later cohort study found that the costs were similar to deceased donor transplantation when LDLT was performed in highly experienced transplant centers .
However, LDLT poses a risk to the donor. The number of LDLT procedures performed in the United States peaked at 519 in 2001 and then decreased to approximately 320 per year starting in 2003 as enthusiasm for the procedure was tempered by concerns about complications .
This topic will review living donor liver transplantation. Other issues regarding liver transplantation, such as patient selection, medical care of the post-transplantation patient, selection of organs from deceased donors, and complications are discussed elsewhere. (See "Liver transplantation in adults: Patient selection and pretransplantation evaluation" and "Liver transplantation in adults: Long-term management of transplant recipients" and "Liver transplantation in adults: Overview of immunosuppression" and "Liver transplantation: Donor selection" and "Infectious complications in liver transplantation".)
Ethical concerns regarding living donor liver transplantation (LDLT) are related to the potential for donor morbidity and mortality. Opponents argue that it is unacceptable to place a healthy donor at risk of long-term debility or death. Donation of the left lateral segment or left lobe, used primarily in pediatric transplantation, is associated with a 5 to 10 percent chance of surgical complications and a mortality rate of less than 1 percent [6,7]. The estimated mortality for right lobe donation, used in adult-to-adult LDLT, is around 0.5 percent. (See 'Donor outcomes' below.)
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