Living donor liver transplantation. Selection of liver donors and recipients; results

Liver transplantation is the first-line therapy for irreversible acute liver failure, chronic end-stage liver disease, advanced metabolic liver disease, and hepatocellular carcinoma. The ongoing shortage of deceased donor organs and the waiting-list mortality have led to a change in allocation policy with the introduction of the model for end-stage liver disease. Living donation is a further option to reduce the waiting-list mortality. In pediatric recipients, living donation has almost eliminated death while on the waiting list, with excellent short-term and long-term outcomes after transplantation. In contrast, because adult recipients require a greater liver volume, a more extended liver resection is necessary, which increases the donor's perioperative and postoperative morbidity and mortality risk. The donor's safety is the greatest concern; therefore, meticulous evalua-tion and selection of the living donor is the basic prerequisite to reduce the donor risk. The postoperative outcome after living donor liver transplantation is comparable with that for full-size postmortal grafts. However, living donation has several advantages, including the elective setting of the transplantation, an excellent proven graft quality, and a short cold ischemia time. Living donor liver transplantation requires high expertise in liver surgery as well as in split-liver transplantation. Therefore, living donor liver transplantation should be performed only in transplant centers meeting these qualifications.