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A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants

Soin, Arvinder Singh, FRCS1; Chaudhary, Rohan Jagat1; Pahari, Hirak1; Pomfret, Elizabeth A.2

doi: 10.1097/TP.0000000000002475
Original Clinical Science—Liver
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Background Although surgical technique in living donor liver transplantation (LDLT) has evolved with a focus on donor safety and recipient challenges, the donor selection criteria remain considerably disparate.

Methods A questionnaire on donor selection was sent to 41 centers worldwide. 24 centers with a combined experience of 19 009 LDLTs responded.

Results Centers were categorized into predominantly LDLT (18) or deceased donor liver transplantation (6), and high- (10) or low-volume (14) centers. At most centers, the minimum acceptable graft-to-recipient weight ratio was 0.7 or less (67%), and remnant was 30% (75%). The median upper limit of donor age was 60 years and body mass index of 33 kg/m2. At 63% centers, age influenced the upper limit of body mass index inversely. Majority preferred aspartate transaminase and alanine transaminase less than 50 IU/mL. Most accepted donors with nondebilitating mild mental or physical disability and rejected donors with treated coronary artery disease, cerebrovascular accident and nonbrain, nonskin primary malignancies. Opinions were divided about previous psychiatric illness, substance abuse and abdominal surgery. Most performed selective liver biopsy, commonly for steatosis, raised transaminases and 1 or more features of metabolic syndrome. On biopsy, all considered macrovesicular and 50% considered microvesicular steatosis important. Nearly all (92%) rejected donors for early fibrosis, and minority for nonspecific granuloma or mild inflammation. Most anatomical anomalies except portal vein type D/E were acceptable at high-volume centers. There was no standard policy for preoperative or peroperative cholangiogram.

Conclusions This first large live liver donor survey provides insight into donor selection practices that may aid standardization between centers, with potential expansion of the donor pool without compromising safety.

An international survey sent to selected living donor liver transplantation centers aggregated donor selection policies across the world.

1 Medanta Institute of Liver Transplantation, Haryana, India.

2 Division of Transplantation, University of Colorado Anschutz Medical Campus, Aurora, CO.

Received 18 March 2018. Revision received 28 September 2018.

Accepted 1 October 2018.

The authors declare no funding or conflicts of interest.

A.S.S. participated in the conception of the work, data analysis, and interpretation, drafting the work, critical revision for important intellectual content and final approval of the version to be published. R.J.C. participated in the data acquisition, analysis and interpretation, drafting and final approval. H.P. participated in the data acquisition, analysis and interpretation, drafting and final approval. E.A.P. participated in the conception, critical revision and final approval of the version to be published.

Correspondence: Arvinder Singh Soin, FRCS, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. (absoin@gmail.com, arvinder.soin@medanta.org).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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