Background: Living donor liver transplantation (LDLT) plays a crucial role in liver transplant programmes, particularly in regions with a scarcity of deceased donor organs and especially for paediatric recipients. LDLT is a complex and demanding procedure which places a healthy living donor in harm's way. Donor safety is therefore the overriding concern. This study aimed to report our standardised approach to the evaluation, technical aspects and outcomes of LDLT donor hepatectomy at Wits Donald Gordon Medical Centre. Methods: The study population consisted of all patients undergoing LDLT donor hepatectomy since the inception of the programme in March 2013 until 2018. Sixty five living donor hepatectomies were performed. Primary outcome measures included donor demographics, operative time, peak bilirubin, aspartate and alanine transaminase levels postoperatively, length of hospital stay and postoperative complications using the Clavien-Dindo classification. Results: The majority of the donors were female, most were parents with mothers being the donor almost 85% of the time. The median operative time was 374 minutes with a downward trend over time as experience was gained. The median length of hospital stay was 7 days. There was no mortality and the complication rate was 30% with the majority being minor (Grade 1). Conclusion: Living donor liver transplant from adult-to-child has been successfully initiated in South Africa. Living donor hepatectomy can be safely performed with acceptable outcomes for the donor. Wait-list mortality however remains unacceptably high. Expansion of LDLT as well as real change in deceased donor policy is required to address this issue.

Objective:Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child's life.Design:A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIV-positive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient.Methods:Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing.Results:Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant.Conclusion:This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient's HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.

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There are only two adult liver transplant programmes in sub-Saharan Africa, and both are in South Africa (SA). The absence of these services for a billion people in this region contrasts starkly with widespread access in high-income countries. In SA, the first programme was established in 1988 at Groote Schuur Hospital in Cape Town and the second programme in 2004 at Wits Donald Gordon Medical Centre (WDGMC) in Johannesburg. [1] WDGMC is uniquely situated as a private academic teaching hospital in the Faculty of Health Sciences at the University of the Witwatersrand. The hospital focuses on teaching and training of specialists and sub-specialists and the provision of specialist care, including liver transplantation. Access to the liver transplant programme is based on need and all adults are prioritised for transplantation based on the severity of their illness. Referrals are widely received from state and private facilities. Survival data on adult orthotopic liver transplants (OLTs) from international programmes have been published. Survival rates differ between middle-income and high-income countries because the volume of transplant procedures is usually much larger in This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.