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Living Donor Liver Transplant (LDLT)

                                                                                  Liver Transplantation: Version 7.0

Living Donor Liver Transplant (LDLT)

After a drop in frequency from 2006 to 2012, living donor transplants are rising, with 359 performed in 2015. LDLT is increasingly concentrated in a smaller number of centers. With a peak volume of 524 in 2001, it had declined to 246 in 2012. The centers report that most of this decline had been related to better use of extended criteria livers, more “splits” being performed on deceased donor livers and the increased concern over the outcomes of the living donor. Of the 359 LDLTs performed in 2015, two-thirds were done in only 15 centers. The indications for choosing a living donor transplant are not clear cut and the donor is placed at considerable risk. Since waiting time is determined by the MELD/PELD score in patients who do not qualify for Status 1A or 1B and not time on the list, the sickest patients tend to be transplanted quickly with livers from deceased donors. Thus, LDLT is often reserved for those patients who are disadvantaged by the MELD/PELD system: patients with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) or patients with low MELD/PELD scores for whom exceptions are not granted, e.g., small cholangiocarcinomas that are generally considered untreatable (still considered experimental). Experience with biliary tract surgery and hepatic resections is very important. Patients considering LDLT should only consider those centers with a large experience in biliary tract surgery, biliary tract reconstructions, hepatic resections and LDLT.

Living donor transplants may increase again if the supply of deceased donors continues to decline. This is a trend most centers will actively follow, since many of them have ceased performing these.

LDLT is not free from significant donor morbidity:
        •    Up to 30% of donors will have a complication following surgery
              that requires re-hospitalization.  
        •    Donor mortality is as high as 0.5%.  Thus, out of 1,000 donors, as many as
              five may die and 300 may have significant complications following donation.  
        •    The average out of pocket expense incurred by donors was reported to be
              approximately $3,500.
        •    In spite of generally being performed on a relatively healthy population
              of liver disease candidates, the outcomes when compared with DDLT
              are about the same.