Donor selection limits use of living-related liver transplantation

Abstract

The purpose of this investigation was to assess the applicability of living-related liver transplantation in an established regional transplant program by determining the frequency of acceptable living donors from an unselected population of pediatric transplant candidates and identify specific factors limiting application of this technique. During the period May 1992 to May 1994, all children accepted as transplant candidates at the University of California-San Francisco were evaluated for potential living-related liver transplantation. Indications for transplantation and patient demographics represented the spectrum anticipated at a regional center. Donor evaluation was performed using a three-phase evaluation process we have previously reported. Retrospective analysis identified 75 potential donors for 38 pediatric candidates (age range, 17 days to 14.5 years; mean, 5.1 years). Twenty-three percent of potential donors declined evaluation. Of the 75 potential donors, only 10 (13%) were found to be acceptable for donation. The leading causes for donor declination were significant medical history (23%), ABO blood group incompatibility (23%), and psychosocial history (20%). Of the 38 recipient candidates, 9 (23%) were offered living-donor transplantation. Five patients have received living-donor transplantation, and 4 patients await the procedure when medical indications exist. Seventy-seven percent of recipient candidates received or are awaiting cadaveric transplantation. These results suggest that current donor criteria markedly limit the application of living-related liver transplantation. (HEPATOLOGY 1995;22:1122-1126 Liver transplantation is now the standard of care in both adult and pediatric patients afflicted with acute or chronic end-stage liver disease. In past years, the disproportionately high mortality rate observed in chil- dren as compared with adults awaiting liver transplantation reflected the disparity between pediatric organ demand and donor supply.' The technique of surgical reduction of cadaveric livers for the treatment of children (reduced-size liver transplantation) has lowered this di~parity.'.~ However, the rapid increase in the number of adult candidates requiring liver transplantation has created a global organ shortage affecting both children and adults.8 Living-related liver transplantation (LRLT) was introduced in anticipation of the current scarcity and is an established, highly effective therapy for ~hildren.~,'-'~ LRLT offers several immediate and theoretical advantages that benefit both the individual and community of recipients. Intensive medical screening of the donor selects for an optimal graft, which, using current surgical techniques that avoid warm ischemia, has a lower risk of primary graft n o n f u n~t i o n .~~' '~~'~~~ Fu rthermore, procurement as an elective procedure provides flexibility in medical timing for transplantation. Strong et all' reported the first successful living donation, and Broelsch et a1 were the first group to establish a living donor transplant ...

Long-term complications of living donor liver transplantation

“…Grewal et al 20 (University of Chicago, Chicago, IL) and Yamaoka et al 18 (Kyoto University, Kyoto, Japan) each reported outcomes of 100 living liver transplant donors with very similar findings. Interestingly, their data have been mirrored by smaller studies in North America 22 and Europe. 23,24 The overall incidence of complications ranged from 15% to 20%, with approximately half classified as serious (requiring either a surgical or interventional procedure or increasing hospital stay) and half classified as not serious.…”

“…Marcos et al 16 and Todo 11 each reported no significant donor complications in series of 40 and 27 right-lobe grafts, respectively, whereas Testa et al 13 reported an overall complication rate greater than 50% in the transplantation of 30 right-lobe grafts. In a survey of 30 North American transplant centers that performed 208 adult LDLTs, Renz et al 22 found an overall donor complication rate of 10%. The most common donor complication was postoperative biliary leak (n ϭ 6), typically treated by percutaneous drainage.…”

Evaluation of 100 patients for living donor liver transplantation

“…Renz et al 4 published their experience in the evaluation of 38 potential pediatric transplant recipients. Seventy-five potential donors were identified for these 38 potential recipients.…”

Practices for Supporting and Confirming Decision-Making Involved in Kidney and Liver Donation by Related Living Donors in Japan: A Nationwide Survey

“…In a similar context, a number of consensus statements from Europe and the United States (8) have recommended the use of an independent living donor advocate (ILDA) for living organ donors, and this has also been reported in various programs and regional protocols (14)(15)(16)(17)(18)(19)(20)(21)). An ILDA is defined as ''a professional who is not involved in the recipient's care, who advocates the welfare of the potential donor, and ensures safe evaluation and protection of the donor's rights,'' (13) but this role is not necessarily consistent and may vary between programs; for example, it may range from the provision of education, policy monitoring, and donor advocacy to active participation in the evaluation (13).…”