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Living donor liver transplantation: eliminating the wait for death in end-stage liver disease?

Abstract

Adult-to-adult living donor liver transplantation (A2ALDLT), outside of Asia, remains an important yet underutilized gift of life. For patients with end-stage liver disease, A2ALDLT is a proven transplantation option, with lower waiting list mortality and suffering, and equivalent or better allograft and patient survival than deceased-donor liver transplantation (DDLT). The risks to living donors and the benefit to their recipients have been carefully defined with long-term level 1 and 2 evidence-based study. An overview of the development and practice of living donor liver transplant (LDLT), including donor and recipient surgical allograft innovation, is provided. The issues of recipient selection, outcomes and morbidity, including disease-variable study and challenges past and present are presented in comparison with DDLT cohorts, and future insights are described. Central to practice is the careful and concise review of donor evaluation and selection and donor outcome, morbidity, quality of life and present and future strategies for donor advocacy and growth of the technique.

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Figure 1: Four-step evaluation of donors before transplantation employed at the author's institution.

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Acknowledgements

R.A.F. acknowledges the support of grants for Adult to adult living donor liver transplantation (A2ALL-1, NIH Grant R01/DK-02-010 (R01 DK62498-02)), Genes related to hepatocellular carcinoma progression in living donor and deceased donor transplant (GR2HCC, NIH National Institute of Diabetes and Digestive and Kidney Diseases Grant 1 R01 DK069859-01A2) and Adult to adult living donor transplantation-2 (A2ALL-2, NIH Grant U01 DK062531).

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Correspondence to Robert A. Fisher.

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Fisher, R. Living donor liver transplantation: eliminating the wait for death in end-stage liver disease?. Nat Rev Gastroenterol Hepatol 14, 373–382 (2017). https://doi.org/10.1038/nrgastro.2017.2

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