Assessment of the global practice of living donor liver transplantation. (14th September 2021)

• Record Type: Journal Article
• Authors: Emamaullee, Juliet; Conrad, Claire; Kim, Michelle; Goldbeck, Cameron; Kwon, Yong; Singh, Pranay; Niemann, Claus U.; Sher, Linda; Genyk, Yuri
• Is Part Of: Transplant international. Volume 34:Number 10(2021)
• Page Start: 1914
• Page End: 1927
• Publication Date: 2021-09-14
• Subjects: donor selection -- global health -- living donor liver transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13960
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Criteria that drive the selection and utilization of living liver donors are limited. Herein, the global availability of living donor liver transplantation (LDLT) and components of donor selection and utilization were assessed via an international survey. There were 124 respondents representing 41 countries, including 47 from Asia/Middle East (A/ME), 20 from Europe, and 57 from the Americas. Responses were obtained from 94.9% of countries with ≥10 LDLT cases/year. Most centers (82.3%) have defined donor age criteria (median 18–60 years), while preset recipient MELD cutoffs (median 18–30) were only reported in 54.8% of programs. Overall, 67.5% of programs have preset donor BMI (body mass index) ranges (median 18–30), and the mean acceptable macrosteatosis was highest for A/ME (20.2 ± 9.2%) and lowest for Americas (16.5 ± 8.4%, P = 0.04). Americas (56.1%) and European (60.0%) programs were more likely to consider anonymous donors versus A/ME programs (27.7%, P = 0.01). There were no differences in consideration of complex anatomical variations. Most programs (75.9%) perform donor surgery via an open approach, and A/ME programs are more likely to use microscopic arterial reconstruction. Despite variations in practice, key aspects of living donor selection were identified. These findings provide a contemporary reference point as LDLT continues to expand into areas with limited access to liver transplantation. Abstract : The objective of this global survey was to explore differing patterns and identify most common practices related to living liver donor liver transplantation (LDLT). In all, 124 respondents from 41 countries, representing 94.9% of countries with >10 LDLT/year completed a survey. These findings provide a contemporary reference point as LDLT continues to expand into areas with limited access to liver transplantation.